Indiana Psychiatric Associates LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

INDIANA PSYCHIATRIC ASSOCIATES LLC

Practice address

4656 W Jefferson Blvd Ste 201
Fort Wayne, IN 46804-6857

Phone

(978) 000-0001

NPI assigned

Sep 28, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Satya Kishore Gutta, MD

Title

Authorized Official

Phone

(260) 208-9676

Specialties & licenses 2

Addresses

Other names 3

• Indiana TMS Doing business as
• QAM Doing business as
• QPM Doing business as

Locations

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1942972047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD STE 201",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD STE 201",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857",
            "telephone_number": "978-000-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PSYCHIATRIC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "GUTTA",
        "authorized_official_first_name": "SATYA",
        "authorized_official_middle_name": "KISHORE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "260-208-9676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana TMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QAM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QPM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QPM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Indiana Pediatric Dental & Anesthesia LLC
• Indiana Physical Therapy Inc
• Indiana Physical Therapy, Inc
• Indiana Plastic Surgery Center, PC
• Indiana Professional Psychological Services, P.C.
• Indiana Retina Center LLC
• Indiana Surgical Specialists, LLC
• Indiana University
• Indiana University Health Urgent Care Centers, LLC
• Indiana University Health Urgent Care Centers, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.