NPIMap

Organization Active NPI

Northeast Indiana Colon Rectal Surgeons PC

  • Colon & Rectal Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1912998014
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
50004032A Issued in IN
Legal business name
NORTHEAST INDIANA COLON RECTAL SURGEONS PC
Practice address
11141 Parkview Plaza Dr
Suite 310
Fort Wayne, IN 46845-1701
Phone
(260) 489-8898
Fax
(260) 373-4695
NPI assigned
Oct 31, 2005
Last updated
Feb 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Paul J. Raiman, M.D.NPI 1114919131
Title
Owner/Practitioner
Phone
(260) 489-8898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208C00000X 50004032A IN Primary

Addresses

Primary practice location

11141 Parkview Plaza Dr
Suite 310
Fort Wayne, IN 46845-1701

Mailing address

11141 Parkview Plaza Dr
Suite 310
Fort Wayne, IN 46845-1701
Phone (260) 489-8898

Other identifiers 1

IdentifierTypeStateIssuer
2053852MedicaidOH

National Provider Directory

National Provider Directory

Locations

7910 W Jefferson Blvd
Ste 104
Fort Wayne, IN 46804
Phone (219) 432-1780

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1912998014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR",
            "address_2": "SUITE 310",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-489-8898",
            "fax_number": "260-373-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR",
            "address_2": "SUITE 310",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-489-8898",
            "fax_number": "260-373-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDIANA COLON RECTAL SURGEONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "RAIMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "260-489-8898",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "IN",
            "license": "50004032A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2053852",
            "state": "OH"
        }
    ],
    "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 Feb 28, 2008; 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.