St Joseph Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ST JOSEPH MEDICAL GROUP INC

Practice address

1109 W Maumee St
Angola, IN 46703-1329

Phone

(260) 665-2131

NPI assigned

Apr 20, 2006

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debbie T Brewer

Title

Director of Provider Enrollment

Phone

(615) 465-7626

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St Joseph Medical Group Inc

  • General Practice Physician
  • Fort Wayne, IN
  • NPI 1811952070

  O20040525001030

  Same enrollment

Tax ID family

St Joseph Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St Joseph Medical Group Inc

  • General Practice Physician
  • Fort Wayne, IN
  • NPI 1811952070
  NPD tax ID

Locations

Practitioners 43

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.

• Dorothea Addo, MD

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1063478360
  NPD
• John Addo, MD

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1922063189

  General Practice

  NPD
• Robert Douglass Barnes, MD

  • Pediatrics Physician
  • New Haven, IN
  • NPI 1629008024
  NPD
• Loretta Bazur-Persing, NP

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1316192511
  NPD
• Sarah A Brady, RN, MSN, NP-C

  • Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1477864239
  NPD
• John B Brinkman, MD

  • Urology Physician
  • Fort Wayne, IN
  • NPI 1881668150
  NPD
• Matthew A Byers, M.D.

  • Obstetrics & Gynecology Physician
  • Columbia City, IN
  • NPI 1124314398
  NPD
• Christopher Thomas Collie, D.O.

  • Anesthesiology Physician
  • Peru, IN
  • NPI 1427025550
  NPD
• Mark D Dabagia, MD

  • Urology Physician
  • Fort Wayne, IN
  • NPI 1891795852
  NPD
• Michelle M Diss, NP

  • Nurse Practitioner
  • Kendallville, IN
  • NPI 1497198568
  NPD
• Ibad Ui-Haq Farooqui, MD

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1427499318
  NPD
• Pamela Kinder Fountain, MSN, RNC, APRN-BC

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1194955757
  NPD

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1801851902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 W MAUMEE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467031329",
            "telephone_number": "260-665-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 W MAUMEE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467031329",
            "telephone_number": "260-665-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100268520",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Edwin Smith, PH.D.
• William A Smith, MD
• Zoey Smith
• Spine Technology and Rehabilitation, P.C.
• Suzanne K Sprague, L.C.S.W.
• Carter Stafford, PHARMD
• Stay Home Senior Care Inc
• Christina Louise Stayback
• Melissa Stemen, NP-C
• Steuben County Auditor (Steuben County EMS)

• Family Medicine Physician in Angola, IN
• Providers in Angola, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.