Active NPI
Bruce Allan Guebard, M.D.
- Family Medicine Physician
- Fort Wayne, IN
National Provider Identifier
1881709608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01027774A
- Practice address
- 5104 N Clinton St
Fort Wayne, IN 46825-5720 - Phone
- (260) 422-2481
- Fax
- (260) 969-3067
- NPI assigned
- Aug 20, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01027774A | IN | Primary |
Addresses
Primary practice location
5104 N Clinton St
Fort Wayne, IN 46825-5720
Mailing address
1234 E Dupont Rd
Suite1
Fort Wayne, IN 46825-1545
Phone (260) 373-9700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000595574 | Other | IN | ANTHEM |
| 100054660 | Medicaid | IN | |
| P00698414 | Other | IN | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| 01027774A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| First Care Family Physicians, PC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- bguebard3520@direct.parkviewexchange.com
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Fort Wayne, IN
- NPI 1659372274
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1881709608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 E DUPONT RD",
"address_2": "SUITE1",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251545",
"telephone_number": "260-373-9700",
"fax_number": "260-373-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5104 N CLINTON ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255720",
"telephone_number": "260-422-2481",
"fax_number": "260-969-3067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUEBARD",
"first_name": "BRUCE",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01027774A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000595574",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100054660",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00698414",
"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 Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.