Northeast Indiana Genetic Counseling Center Inc

Primary specialty

Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X

License

01022953 Issued in IN

Legal business name

NORTHEAST INDIANA GENETIC COUNSELING CENTER INC

Practice address

11143 Parkview Plaza Dr
Ste. 311
Fort Wayne, IN 46845-1701

Phone

(260) 482-3886

Fax

(260) 482-1910

NPI assigned

Dec 2, 2005

Last updated

May 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia I Bader, M.D.

Title

Physician

Phone

(260) 482-3886

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 3

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.

• Angela Michelle Bauer, N.P.

  • Family Nurse Practitioner
  • Fort Wayne, IN
  • NPI 1497058812
  NPD (past)
• Kelsey Johnson

  • Genetic Counselor (M.S.)
  • Fort Wayne, IN
  • NPI 1255774501
  NPD (past)
• Meghan Lundy, MS, LCGC

  • Genetic Counselor (M.S.)
  • Fort Wayne, IN
  • NPI 1942639216
  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1881678860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR",
            "address_2": "STE. 311",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-482-3886",
            "fax_number": "260-482-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR",
            "address_2": "STE. 311",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-482-3886",
            "fax_number": "260-482-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA GENETIC COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "BADER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "260-482-3886",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207SC0300X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Cytogenetics",
            "state": "IN",
            "license": "01022953",
            "primary": false
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "IN",
            "license": "01022953",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01022953",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080650A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100360290A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Genetics (M.D.) Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Genetics (M.D.) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; 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.