Individual provider Active NPI

Ronald Furniss, LCSW, LCAC

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1962540203
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34001026A Issued in IN
Practice address
2712 S Calhoun St
Fort Wayne, IN 46807-1402
Phone
(260) 744-4326
Fax
(260) 744-0188
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34001026A IN Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 87000425A IN

Addresses

Primary practice location

2712 S Calhoun St
Fort Wayne, IN 46807-1402

Mailing address

2712 S Calhoun St
Fort Wayne, IN 46807-1402
Phone (260) 744-4326

Other identifiers 1

IdentifierTypeStateIssuer
200090360AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111130000546 IN Practitioner - Clinical Social Worker 4688848682 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
87000425AINMDAddiction (Substance Use Disorder) Counselor
34001026AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family & Childrens Service of Fort Wayne Inc CurrentSince Sep 1, 1999 Accepting new patients

Locations

2712 S Calhoun St
Fort Wayne, IN 46807
Phone (219) 744-4326

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.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1962540203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468071402",
            "telephone_number": "260-744-4326",
            "fax_number": "260-744-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 S CALHOUN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468071402",
            "telephone_number": "260-744-4326",
            "fax_number": "260-744-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FURNISS",
        "first_name": "RONALD",
        "credential": "LCSW, LCAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001026A",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87000425A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200090360A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.