NPIMap

Individual provider Active NPI

Joseph D Fortin, D.O.

  • Interventional Pain Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1841292612
Registry record updated Oct 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
02001553A Issued in IN
Practice address
9502 Lima Road
Ste 103
Fort Wayne, IN 46818-9270
Phone
(260) 459-7313
Fax
(260) 436-0628
NPI assigned
Aug 11, 2005
Last updated
Oct 18, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 02001553A IN
Interventional Pain Medicine Physician 208VP0014X 02001553A IN Primary

Addresses

Primary practice location

9502 Lima Road
Ste 103
Fort Wayne, IN 46818-9270

Mailing address

9502 Lima Road
Suite 103
Fort Wayne, IN 46818-9270
Phone (260) 459-7313

Other identifiers 2

IdentifierTypeStateIssuer
250008768OtherINRR MEDICARE
200024910AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100712000709 IN Practitioner - Pain ManagementPractitioner - Physical Medicine and Rehabilitation 4587646989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Michigan State University College of Osteopathic Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9502 Lima Rd
Suite 103
Fort Wayne, IN 46818-9517
Phone (260) 459-7313

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Spine Technology and Rehabilitation PC Interventional Pain Medicine Past Accepting new patients
Spine Technology and Rehabilitation, P.C. Physical Medicine & Rehabilitation Past Accepting new patients
Lima Memorial Joint Operating Company Interventional Pain Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: spinetechnologyandrehabilitation.josephfortin@120486.advancedmd-direct.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508284800000",
    "number": "1841292612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9502 LIMA ROAD",
            "address_2": "SUITE 103",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468189270",
            "telephone_number": "260-459-7313",
            "fax_number": "260-436-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9502 LIMA ROAD",
            "address_2": "STE 103",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468189270",
            "telephone_number": "260-459-7313",
            "fax_number": "260-436-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIN",
        "first_name": "JOSEPH",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IN",
            "license": "02001553A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "02001553A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "250008768",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200024910A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.