NPIMap

Organization Active NPI

Fort Wayne Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Lagrange, IN
National Provider Identifier
1881909935
Registry record updated Nov 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
50002482 Issued in IN
Legal business name
FORT WAYNE ORTHOPEDICS, LLC
Practice address
207 N Townline Rd
Lagrange, IN 46761-1325
Phone
(260) 436-8686
Fax
(260) 459-0036
NPI assigned
Aug 13, 2010
Last updated
Nov 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2013

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

Authorized official

Name
Jerald L. Cooper, M.D.NPI 1598768566
Title
M.D./President
Phone
(260) 436-8686

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50002482 IN
Orthopaedic Surgery Physician 207X00000X 50002482 IN Primary
Orthopaedic Hand Surgery Physician 207XS0106X 50002482 IN
Orthopaedic Surgery of the Spine Physician 207XS0117X 50002482 IN
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 50002482 IN
Orthopaedic Trauma Physician 207XX0801X 50002482 IN
Podiatrist 213E00000X 50002482 IN
Foot Surgery Podiatrist 213ES0131X 50002482 IN

Addresses

Primary practice location

207 N Townline Rd
Lagrange, IN 46761-1325

Mailing address

PO Box 2526
Fort Wayne, IN 46801-2526
Phone (260) 436-8686

Other identifiers 3

IdentifierTypeStateIssuer
0162610003OtherINDME PTAN
100210470AMedicaidIN
100210470MedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1881909935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2526",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468012526",
            "telephone_number": "260-436-8686",
            "fax_number": "260-432-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N TOWNLINE RD",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611325",
            "telephone_number": "260-436-8686",
            "fax_number": "260-459-0036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE ORTHOPEDICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "M.D./PRESIDENT",
        "authorized_official_telephone_number": "260-436-8686",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "50002482",
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "50002482",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IN",
            "license": "50002482",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME PTAN",
            "identifier": "0162610003",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100210470A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100210470",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, IN

Sources for this page

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

Verify at the official NPI Registry.