NPIMap

Organization Active NPI

Ophthalmology Consultants of Fort Wayne, P.C.

  • Ophthalmology Physician
  • Fort Wayne, IN
National Provider Identifier
1861476210
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
50002512A Issued in IN
Legal business name
OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE, P.C.
Practice address
7232 Engle Rd
Fort Wayne, IN 46804-2222
Phone
(260) 436-7205
Fax
(260) 432-1339
NPI assigned
Nov 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Authorized official

Name
Tricia Pieper
Title
Practice Manager
Phone
(260) 436-7205

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 50002512A IN Primary

Addresses

Primary practice location

7232 Engle Rd
Fort Wayne, IN 46804-2222

Mailing address

7232 Engle Rd
Fort Wayne, IN 46804-2222
Phone (260) 436-7205

Other identifiers 1

IdentifierTypeStateIssuer
100103080AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816001378 IN Part B Supplier - Clinic/Group Practice 4789657974 Receives reassigned benefits from 7 practitioners
Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ophthalmology Consultan5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

10186 DuPont Circle Dr E
Fort Wayne, IN 46825
Phone (219) 436-7205

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1861476210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-436-7205",
            "fax_number": "260-432-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7232 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042222",
            "telephone_number": "260-436-7205",
            "fax_number": "260-432-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "PIEPER",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "260-436-7205"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "50002512A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100103080A",
            "state": "IN"
        }
    ],
    "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 Aug 5, 2020; 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.