NPIMap

Organization Active NPI

Fort Wayne Medical Institute

  • Specialist
  • Fort Wayne, IN
National Provider Identifier
1659549475
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
01042585 Issued in IN
Legal business name
FORT WAYNE MEDICAL INSTITUTE
Practice address
4424 E State Blvd
Fort Wayne, IN 46815-6917
Phone
(260) 483-4433
Fax
(260) 483-4223
NPI assigned
Feb 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Hassan Taki, MDNPI 1114911807
Title
Owner
Phone
(260) 483-4433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 01042585 IN Primary

Addresses

Primary practice location

4424 E State Blvd
Fort Wayne, IN 46815-6917

Mailing address

4424 E State Blvd
Fort Wayne, IN 46815-6917
Phone (260) 483-4433

Other identifiers 2

IdentifierTypeStateIssuer
1114911807OtherPROVIDER NPI
0963453MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120307000493 IN Part B Supplier - Clinic/Group Practice 7214992114 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

4424 E State Blvd
Fort Wayne, IN 46815
Phone (219) 483-4433

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1659549475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156917",
            "telephone_number": "260-483-4433",
            "fax_number": "260-483-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156917",
            "telephone_number": "260-483-4433",
            "fax_number": "260-483-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE MEDICAL INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "TAKI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-483-4433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "01042585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1114911807",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0963453",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.