Active NPI
Fort Wayne Orthopedics, LLC
- Orthopaedic Surgery Physician
- Fort Wayne, IN
National Provider Identifier
1811202963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 50002482
- Legal business name
- FORT WAYNE ORTHOPEDICS, LLC
- Practice address
- 3816 New Vision Dr
Fort Wayne, IN 46845-1708 - Phone
- (260) 436-8686
- Fax
- (260) 459-0036
- NPI assigned
- Aug 13, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jerald L. Cooper, M.D.
- Title
- M.D./President
- Phone
- (260) 436-8686
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 50002482 | IN | Primary |
| Orthopaedic Hand Surgery Physician | 207XS0106X | 50002482 | IN | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | 50002482 | IN | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 50002482 | IN | |
| Orthopaedic Trauma Physician | 207XX0801X | 50002482 | IN | |
| Podiatrist | 213E00000X | 50002482 | IN | |
| Foot Surgery Podiatrist | 213ES0131X | 50002482 | IN | |
| Physician Assistant | 363A00000X | 50002482 | IN |
Addresses
Primary practice location
3816 New Vision Dr
Fort Wayne, IN 46845-1708
Mailing address
PO Box 2526
Fort Wayne, IN 46801-2526
Phone (260) 436-8686
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0162610007 | Other | IN | DME PTAN |
| 100210470 | Medicaid | IN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281657600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1385510400000",
"number": "1811202963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2526",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468012526",
"telephone_number": "260-436-8686",
"fax_number": "260-432-5075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3816 NEW VISION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451708",
"telephone_number": "260-436-8686",
"fax_number": "260-459-0036"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORT WAYNE ORTHOPEDICS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-08-13",
"last_updated": "2013-11-27",
"status": "A",
"authorized_official_last_name": "COOPER",
"authorized_official_first_name": "JERALD",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "M.D./PRESIDENT",
"authorized_official_telephone_number": "260-436-8686",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "IN",
"license": "50002482",
"primary": true
},
{
"code": "207XS0106X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Hand Surgery",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XS0117X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XX0005X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Sports Medicine",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "207XX0801X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery, Orthopaedic Trauma",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist, Foot Surgery",
"state": "IN",
"license": "50002482",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "IN",
"license": "50002482",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME PTAN",
"identifier": "0162610007",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100210470",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
- Fort Wayne Orthopaedics LLC
- Fort Wayne Orthopaedics, LLC
- Fort Wayne Orthopaedics, LLC
- Fort Wayne Orthopaedics, LLC
- Fort Wayne Orthopaedics, LLC Surgicenter
- Fort Wayne Pediatric Dentistry LLC
- Fort Wayne Pediatrics, PC
- Fort Wayne Physical Medicine P C
- Fort Wayne Primary Care LLC
- Fort Wayne Prosthodontics, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.