NPIMap

Organization Active NPI

Indiana Medical Associates, LLC

  • Internal Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1780628545
Registry record updated Jan 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INDIANA MEDICAL ASSOCIATES, LLC
Practice address
7900 W Jefferson Blvd
Suite 201
Fort Wayne, IN 46804-4128
Phone
(260) 969-7100
Fax
(260) 969-7101
NPI assigned
Jun 15, 2006
Last updated
Jan 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2010

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

Authorized official

Name
Lowell Teska
Title
Ceo
Phone
(260) 969-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

7900 W Jefferson Blvd
Suite 201
Fort Wayne, IN 46804-4128

Mailing address

7900 W Jefferson Blvd
Suite 201
Fort Wayne, IN 46804-4128
Phone (260) 969-7100

Other identifiers 3

IdentifierTypeStateIssuer
200250290MedicaidIN
2042720MedicaidOH
200190390MedicaidIN

National Provider Directory

National Provider Directory

Locations

2512 E DuPont Rd
Ste 110
Fort Wayne, IN 46825
Phone (260) 434-6076

7900 W Jefferson Blvd
#200
Fort Wayne, IN 46804

7900 W Jefferson Blvd
#9605
Fort Wayne, IN 46804

140 Fox Rd
Ste 405
Van Wert, OH 45891
Phone (419) 238-9333

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262649600000",
    "number": "1780628545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD",
            "address_2": "SUITE 201",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-969-7100",
            "fax_number": "260-969-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD",
            "address_2": "SUITE 201",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-969-7100",
            "fax_number": "260-969-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2010-01-05",
        "status": "A",
        "authorized_official_last_name": "TESKA",
        "authorized_official_first_name": "LOWELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-969-7100"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200250290",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2042720",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200190390",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 5, 2010; 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.