Active NPI
Donald A Durecki, MD
- Obstetrics & Gynecology Physician
- Warsaw, IN
National Provider Identifier
1982648721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- IN01053282A
- Practice address
- 1275 Provident Dr
Warsaw, IN 46580-3265 - Phone
- (574) 269-4026
- Fax
- (574) 269-7444
- NPI assigned
- Jun 15, 2006
- Last updated
- Jan 31, 2018
- 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | IN01053282A | IN | Primary |
Addresses
Primary practice location
1275 Provident Dr
Warsaw, IN 46580-3265
Mailing address
2518 E Dupont Rd
Fort Wayne, IN 46825-1675
Phone (260) 432-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200304590 | Medicaid | IN |
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 |
|---|---|---|---|
| IN01053282A | IN | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517356800000",
"number": "1982648721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2518 E DUPONT RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251675",
"telephone_number": "260-432-4400",
"fax_number": "260-969-6898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 PROVIDENT DR",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803265",
"telephone_number": "574-269-4026",
"fax_number": "574-269-7444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURECKI",
"first_name": "DONALD",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2018-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "IN",
"license": "IN01053282A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200304590",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warsaw, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.