St Joseph Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ST JOSEPH MEDICAL GROUP INC

Practice address

2622 Lake Ave
Fort Wayne, IN 46805-5410

Phone

(260) 425-3100

NPI assigned

Apr 19, 2006

Last updated

Dec 15, 2015By 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

Sophia L Arwood

Title

Director of Physician Operations

Phone

(615) 628-6038

Specialties & licenses 14

Addresses

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

  • Family Medicine Physician
  • Angola, IN
  • NPI 1801851902

  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

  • Family Medicine Physician
  • Angola, IN
  • NPI 1801851902
  NPD tax ID

Locations

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.

• Dorothea Addo, MD

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

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1922063189
  Medicare reassignment NPD
• Robert Douglass Barnes, MD

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

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

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

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

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

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

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

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

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

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

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450137600000",
    "number": "1811952070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055410",
            "telephone_number": "260-425-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2622 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055410",
            "telephone_number": "260-425-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2015-12-15",
        "status": "A",
        "authorized_official_last_name": "ARWOOD",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF PHYSICIAN OPERATIONS",
        "authorized_official_telephone_number": "615-628-6038"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SRT Prosthetics & Orthotics LLC (ForMotion Clinic)
• St Joseph Health System LLC (Lutheran Downtown Hospital)
• St Joseph Health System LLC (St. Joseph Hospital Gero)
• St Joseph Health System LLC (Stellhorn Freestanding Emergency Dept)
• St Joseph Health System LLC (Transitional Care Unit of St Joseph)
• St. Joseph Health System LLC (St. Joseph Hospital Home Health Care)
• St. Joseph Health System, LLC (Lutheran Downtown Hospital)
• St. Joseph Health System, LLC (Lutheran Downtown Hospital)
• St. Joseph Township EMS
• St. Vincent Hospital and Health Care Center, Inc. (St. Vincent Pediatric Subspecialties)

• General Practice Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• General Practice Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.