Active NPI
Russell Vaughn Maples, M.D.
- Allergy & Immunology Physician
- Fort Wayne, IN
National Provider Identifier
1871556951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 01058221A
- Practice address
- 7222 Engle Road
Fort Wayne, IN 46804-2222 - Phone
- (260) 432-5005
- Fax
- (260) 432-6003
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 01058221A | IN | Primary |
| Allergy & Immunology Physician | 207K00000X | 019557 | GA | |
| Allergy & Immunology Physician | 207K00000X | 17076 | SC | |
| Allergy & Immunology Physician | 207K00000X | MD - 11810 | HI | |
| Pulmonary Disease Physician | 207RP1001X | 01058221A | IN | |
| Pulmonary Disease Physician | 207RP1001X | 019557 | GA | |
| Pulmonary Disease Physician | 207RP1001X | 17076 | SC | |
| Pulmonary Disease Physician | 207RP1001X | MD - 11810 | HI |
Addresses
Primary practice location
7222 Engle Road
Fort Wayne, IN 46804-2222
Mailing address
7222 Engle Road
Fort Wayne, IN 46804-2222
Phone (260) 432-5003
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200460250 | Medicaid | IN | |
| 000000024268 | Other | M-PLAN | |
| 000000298856 | Other | ANTHEM BCBS | |
| 1597162009 | Other | CIGNA | |
| 352007446100 | Other | CARESOURCE | |
| P00153026 | Other | RAILROAD MEDICARE | |
| 10987543 | Other | CAQH | |
| 4395006 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD - 11810 | HI | MD | Allergy & Immunology Physician |
| 17076 | SC | MD | Allergy & Immunology Physician |
| 019557 | GA | MD | Pulmonary Disease Physician |
| 01058221A | IN | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NPI 1508468638 | Allergy & Immunology | Past | Accepting new patients |
| Allergy Partners, PLLC | Allergy & Immunology | Past | Accepting new patients |
| Allergy & Asthma Center, PC | Allergy & Immunology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba The Allergy and Asthma Center, PC
- Allergy & Immunology Physician
- Fort Wayne, IN
- NPI 1386606911
-
dba Allergy Partners of the Upstate
- Allergy & Immunology Physician
- Greenville, SC
- NPI 1215927462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331683200000",
"number": "1871556951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7222 ENGLE ROAD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468042222",
"telephone_number": "260-432-5003",
"fax_number": "260-432-6003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7222 ENGLE ROAD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468042222",
"telephone_number": "260-432-5005",
"fax_number": "260-432-6003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAPLES",
"first_name": "RUSSELL",
"middle_name": "VAUGHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2012-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "IN",
"license": "01058221A",
"primary": true
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "GA",
"license": "019557",
"primary": false
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "SC",
"license": "17076",
"primary": false
},
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "HI",
"license": "MD - 11810",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "IN",
"license": "01058221A",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "GA",
"license": "019557",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "SC",
"license": "17076",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "HI",
"license": "MD - 11810",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200460250",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M-PLAN",
"identifier": "000000024268",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000298856",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1597162009",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "352007446100",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00153026",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10987543",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4395006",
"state": null
}
],
"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 Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.