Surgery Center of Fort Wayne

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGERY CENTER OF FORT WAYNE

Practice address

1721 Magnavox Way
Fort Wayne, IN 46804-1537

Phone

(317) 450-5441

NPI assigned

Feb 25, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Brandon Ehret

Title

Administrator

Phone

(317) 450-5441

Specialties & licenses 1

Addresses

Electronic endpoints 1

Listed as

Surgery Center of Fort WayneCCN 15C0001211

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Racc Medical Associates LLC

  • Durable Medical Equipment & Medical Supplies
  • Marion, IN
  • NPI 1013676840

  Member Of

  NPD member

Locations

Practitioners 1

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

• Robert Franklin Jackson II, D.O.

  • Orthopaedic Surgery Physician
  • Fort Wayne, IN
  • NPI 1982654828
  NPD (past)

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1780218115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041537",
            "telephone_number": "260-250-0001",
            "fax_number": "260-222-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041537",
            "telephone_number": "317-450-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF FORT WAYNE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "EHRET",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "317-450-5441",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cmclaughlin@capitolstreetsurgery.com",
            "affiliation": "N",
            "address_1": "1721 Magnavox Way",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468041537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Super Shot Inc.
• Superior Van & Mobility
• Supreme Hearing Company, Inc.
• Mahender Reddy Surakanti, MD
• Arvind Surendran, M.D.
• Surgery One Anesthesia, LLC
• Surgicenter Group LLC
• Christina Surine
• Jill Elizabeth Surine
• Manoj R Suryawala, M.D

• Ambulatory Surgical Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.