NPIMap

Organization Active NPI

Integrative Health LLC

  • Adult Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1821669854
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
INTEGRATIVE HEALTH LLC
Practice address
10528 Coldwater Rd
Fort Wayne, IN 46845-1268
Phone
(260) 338-1700
NPI assigned
Jul 9, 2021
Last updated
Jul 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Authorized official

Name
Daniel MillerNPI 1023121779
Title
Owner
Phone
(260) 338-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NU Primary

Addresses

Primary practice location

10528 Coldwater Rd
Fort Wayne, IN 46845-1268

Mailing address

10528 Coldwater Rd
Fort Wayne, IN 46845-1268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210908000721 IN Part B Supplier - Clinic/Group Practice 7618373234 Receives reassigned benefits from 11 practitioners
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Locations

10528 Coldwater Rd
Ste H
Fort Wayne, IN 46845

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1821669854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10528 COLDWATER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10528 COLDWATER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451268",
            "telephone_number": "260-338-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-338-1700"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 9, 2021; 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.