Individual provider Active NPI

Russell Vaughn Maples, M.D.

  • Allergy & Immunology Physician
  • Fort Wayne, IN
National Provider Identifier
1871556951
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
01058221A Issued in IN
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

Updated by the provider on Mar 14, 2012

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
200460250MedicaidIN
000000024268OtherM-PLAN
000000298856OtherANTHEM BCBS
1597162009OtherCIGNA
352007446100OtherCARESOURCE
P00153026OtherRAILROAD MEDICARE
10987543OtherCAQH
4395006OtherAETNA

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

LicenseStateTypeSpecialty
MD - 11810HIMDAllergy & Immunology Physician
17076SCMDAllergy & Immunology Physician
019557GAMDPulmonary Disease Physician
01058221AINMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.