NPIMap

Organization Active NPI

Orthopaedics Northeast PC

Doing business as DBA ONE Anesthesia Services

  • Orthopaedic Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1740268796
Registry record updated May 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPAEDICS NORTHEAST PC
Doing business as
DBA ONE Anesthesia Services
Practice address
5050 N Clinton St
Fort Wayne, IN 46825-5822
Phone
(260) 484-8551
Fax
(260) 482-5060
NPI assigned
Jan 9, 2006
Last updated
May 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2017

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

Authorized official

Name
Barbara J Hathaway
Title
Credentialing Officer
Phone
(260) 408-2203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

5050 N Clinton St
Fort Wayne, IN 46825-5822

Mailing address

5052 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551

Other identifiers 6

IdentifierTypeStateIssuer
CK0104OtherINRAIL ROAD MEDICARE
CC5427OtherINRAILROAD MEDICARE
100054960MedicaidIN
490001781OtherINRAIL RAOD MEDICARE SURG
100274410MedicaidIN
CI5112OtherINRAIL ROAD MEDICARE

Other names 1

  • DBA ONE Anesthesia Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405001087 IN Part B Supplier - Clinic/Group Practice 9234024878 Receives reassigned benefits from 106 practitioners
Practice locations: Columbia City, IN; Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

885 W Connexion Way
Ste 200
Columbia City, IN 46725
Phone (260) 248-9260

11136 Parkview Circle Dr
Fort Wayne, IN 46845

5052 N Clinton St
Fort Wayne, IN 46825
Phone (260) 408-2203

Practitioners & affiliated clinicians

Practitioners 107

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 107

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1740268796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-490-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-484-8551",
            "fax_number": "260-482-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDICS NORTHEAST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2017-05-12",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "260-408-2203"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CK0104",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5427",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100054960",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL RAOD MEDICARE SURG",
            "identifier": "490001781",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274410",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CI5112",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA ONE Anesthesia Services",
            "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 May 12, 2017; 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.