Individual provider Active NPI

Carey Lane Watson, M.D.

  • Pediatric Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1679891097
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
01081997A Issued in IN
Practice address
7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182
Phone
(260) 469-7337
Fax
(260) 469-7340
NPI assigned
May 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 01081997A IN
Pediatric Surgery Physician 2086S0120X 01081997A IN Primary

Addresses

Primary practice location

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182

Mailing address

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182
Phone (260) 469-7337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190722000180 IN Practitioner - General Surgery 3971743295 Reassigns benefits to 1 organization
I20191021001404 OH Practitioner - Pediatric Medicine 3971743295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7613 W Jefferson Blvd
Suite 200
Fort Wayne, IN 46804-4182
Phone (260) 469-7337

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01081997AINMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System CurrentSince Aug 10, 2019 Accepting new patients
The Metrohealth System Surgery CurrentSince Aug 10, 2019 Accepting new patients
Great Lakes Pediatric Surgeons, Inc. Pediatric Surgery CurrentSince Sep 1, 2019 Accepting new patients

Locations

7613 W Jefferson Blvd
Ste 200
Fort Wayne, IN 46804
Phone (260) 469-7337

7613 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 469-7337

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

4229 Pearl Rd
Cleveland, OH 44109
Phone (216) 459-6300

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1679891097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7613 W JEFFERSON BLVD STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044182",
            "telephone_number": "260-469-7337",
            "fax_number": "260-469-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "CAREY",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-10",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01081997A",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IN",
            "license": "01081997A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.