Active NPI
Three Rivers Dermatology, LLC
- Specialist
- Fort Wayne, IN
National Provider Identifier
1992991475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- THREE RIVERS DERMATOLOGY, LLC
- Practice address
- 5650 Coventry LN
Fort Wayne, IN 46804-7140 - Phone
- (260) 436-9696
- Fax
- (260) 436-9424
- NPI assigned
- Sep 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jeffrey Walter Sassmannshausen, M.D.
- Title
- Ceo/Owner
- Phone
- (260) 436-9696
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
5650 Coventry LN
Fort Wayne, IN 46804-7140
Mailing address
5650 Coventry LN
Fort Wayne, IN 46804-7140
Phone (260) 436-9696
Other names 1
- Three Rivers Dermatology
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jsassmannshausen@directaddress.net | Health Information Exchange (HIE) | |
| Direct Messaging Address | aferguson@directaddress.net | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D1001693 | Three Rivers Dermatology | Provider-performed microscopy | Jul 17, 2028 |
National Provider Directory
National Provider DirectoryLocations
5650 Coventry Ln
Fort Wayne, IN 46804
Phone (260) 436-9696
Interoperability endpoints
- aferguson@directaddress.net
- jsassmannshausen@directaddress.net
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Specialist
- Fort Wayne, IN
- NPI 1316928195
-
- Physician Assistant
- Fort Wayne, IN
- NPI 1396248415
-
- Physician Assistant
- Fort Wayne, IN
- NPI 1750390902
-
- Medical Physician Assistant
- Fort Wayne, IN
- NPI 1073963351
-
- Physician Assistant
- Fort Wayne, IN
- NPI 1740905488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1591920000000",
"number": "1992991475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5650 COVENTRY LN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468047140",
"telephone_number": "260-436-9696",
"fax_number": "260-436-9424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5650 COVENTRY LN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468047140",
"telephone_number": "260-436-9696",
"fax_number": "260-436-9424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THREE RIVERS DERMATOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-19",
"last_updated": "2020-06-12",
"certification_date": "2020-06-12",
"status": "A",
"authorized_official_last_name": "SASSMANNSHAUSEN",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "WALTER",
"authorized_official_title_or_position": "CEO/OWNER",
"authorized_official_telephone_number": "260-436-9696",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jsassmannshausen@directaddress.net",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "XML",
"address_1": "5650 Coventry Ln",
"city": "Fort Wayne",
"state": "IN",
"country_code": "US",
"postal_code": "468047140",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "aferguson@directaddress.net",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "xml",
"address_1": "5650 Coventry Ln",
"city": "Fort Wayne",
"state": "IN",
"country_code": "US",
"postal_code": "468047140",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Three Rivers Dermatology",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Three Rivers Dermatology",
"code": "3",
"type": "Doing Business As"
}
]
}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 Jun 12, 2020; 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.