NPIMap

Organization Active NPI

Hutner, Inc.

  • Psychologist
  • Fort Wayne, IN
National Provider Identifier
1720145774
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
20041381A Issued in IN
Legal business name
HUTNER, INC.
Practice address
3240 Mallard Cove LN
Fort Wayne, IN 46804-2883
Phone
(260) 341-5848
Fax
(260) 755-5927
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Authorized official

Name
Dr. Brian Douglas Hutner, PSY.D., HSPPNPI 1417264607
Title
President
Phone
(260) 341-5848

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
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 20041381A IN Primary

Addresses

Primary practice location

3240 Mallard Cove LN
Fort Wayne, IN 46804-2883

Mailing address

3240 Mallard Cove LN
Fort Wayne, IN 46804-2883
Phone (260) 341-5848

Other identifiers 3

IdentifierTypeStateIssuer
200266510MedicaidIN
200412990-AMedicaidIN
200288980MedicaidIN

Other names 1

  • The Ivy Group of Fort Wayne Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391126400000",
    "number": "1720145774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042883",
            "telephone_number": "260-341-5848",
            "fax_number": "260-755-5927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042883",
            "telephone_number": "260-341-5848",
            "fax_number": "260-755-5927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUTNER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2014-01-31",
        "status": "A",
        "authorized_official_last_name": "HUTNER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-341-5848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., HSPP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041381A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200266510",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200412990-A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200288980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Ivy Group of Fort Wayne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.