Iu Health Southwest Fort Wayne Ambulatory Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

IU HEALTH SOUTHWEST FORT WAYNE AMBULATORY SURGERY CENTER LLC

Practice address

4105 Dicke Road
Fort Wayne, IN 46804

Phone

(317) 201-1038

NPI assigned

Jan 20, 2021

Organization subpart

No

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

Authorized official

Name

Erin Kousagan

Title

Executive Director

Phone

(504) 220-8912

Specialties & licenses 1

Addresses

Other names 2

• IU Health Surgery Center Fort Wayne Doing business as
• IU Health Surgery Center on Aboite road Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Listed as

Iu Health Southwest Fort Wayne Ambulatory Surgery Center Dba Iu Health Surgery Center Fort WayneCCN 15C0001219

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Indiana University Health, Inc

  • Durable Medical Equipment & Medical Supplies
  • Lafayette, IN
  • NPI 1902061583

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Wayne Robison, DPM

  • Podiatrist
  • Fort Wayne, IN
  • NPI 1790760882
  NPD (past)

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1992395388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N MERIDIAN ST STE 910",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462041077",
            "telephone_number": "317-805-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 DICKE ROAD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "317-201-1038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IU HEALTH SOUTHWEST FORT WAYNE AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A",
        "authorized_official_last_name": "KOUSAGAN",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "504-220-8912"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IU Health Surgery Center Fort Wayne",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IU Health Surgery Center on Aboite road",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael T Isenberg, MD
• Edna O Isiorho, RN, APN
• Steven Ison
• Vatche A Israbian, MD
• Christine Marie Itt, PHARMD
• IV Hydration Vitamin Therapy LLC
• Ivy Bridge Therapy LLC
• Ciarra Ivy, RBT
• J & a Mobility Transportation
• J & Y Medical LLC

• Ambulatory Surgical Clinic/Center in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Ambulatory Surgical Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.