NPIMap

Organization Active NPI

Fort Wayne Dermatology Consultants Inc

  • Dermatology Physician
  • Fort Wayne, IN
National Provider Identifier
1730277583
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FORT WAYNE DERMATOLOGY CONSULTANTS INC
Practice address
7881 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone
(260) 436-8000
Fax
(260) 432-5587
NPI assigned
Oct 10, 2006
Last updated
Sep 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Dr. Edward C Sarkisian, M.D.NPI 1548368301
Title
President
Phone
(260) 436-8000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
Plastic Surgery Physician 208200000X

Addresses

Primary practice location

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792

Mailing address

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone (260) 436-8000

Other identifiers 3

IdentifierTypeStateIssuer
200459670AMedicaidIN
4463426OtherAETNA
DA4850OtherMEDICARE RAIL ROAD

Other names 1

  • Fort Wayne Dermatology Cons Inc Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040715001094 IN Part B Supplier - Clinic/Group Practice 0042299885 Receives reassigned benefits from 14 practitioners
Practice locations: Warsaw, IN; Fort Wayne, IN; Decatur, IN
O20211018001579 OH Part B Supplier - Clinic/Group Practice 0042299885 Receives reassigned benefits from 2 practitioners
Practice locations: Hicksville, OH; Paulding, OH

National Provider Directory

National Provider Directory

Locations

1100 Mercer Ave
Decatur, IN 46733

955 High St
Ste 2
Decatur, IN 46733
Phone (219) 724-8700

2875 E DuPont Rd
Fort Wayne, IN 46825

3505 N State Road 15
Ste C
Warsaw, IN 46582

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1730277583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-432-5587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-432-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE DERMATOLOGY CONSULTANTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "SARKISIAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-436-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200459670A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4463426",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "DA4850",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Wayne Dermatology Cons Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 27, 2021; 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.