Park Center Inc | |
909 E State Blvd Fort Wayne IN 46805-3404 | |
(260) 481-2700 | |
(260) 481-2717 |
Full Name | Park Center Inc |
---|---|
Speciality | Clinic/Center |
Location | 909 E State Blvd, Fort Wayne, Indiana |
Authorized Official Name and Position | Kris Bigelow (DIRECTOR ENTERPRISE CREDENTIALING &) |
Authorized Official Contact | 2602661403 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Park Center Inc 11109 Parkview Plaza Drive Mailbox 117 Fort Wayne IN 46845 Ph: (260) 373-9700 | Park Center Inc 909 E State Blvd Fort Wayne IN 46805-3404 Ph: (260) 481-2700 |
NPI Number | 1306897004 |
---|---|
Provider Enumeration Date | 05/15/2006 |
Last Update Date | 10/29/2021 |
Certification Date | 10/11/2021 |
Medicare PECOS PAC ID | 5991794794 |
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Medicare Enrollment ID | O20041213000226 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306897004 | NPI | - | NPPES |
100463190 C | Medicaid | IN | |
100463190B | Medicaid | IN | |
300015906 | Other | IN | ADDICTION SERVICES |
100463190A | Medicaid | IN | |
300024898 | Other | IN | ADDICTION SERVICES |
Provider Name | Irene Theresa Hoover |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639103153 PECOS PAC ID: 2860475514 Enrollment ID: I20040611001290 |
Provider Name | Samir Gamal Ishak |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1548257488 PECOS PAC ID: 4880655331 Enrollment ID: I20041019001023 |
Provider Name | Edith L Kenna |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154358406 PECOS PAC ID: 0446212625 Enrollment ID: I20041029000919 |
Provider Name | James H Cheviron |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1588806103 PECOS PAC ID: 9830156579 Enrollment ID: I20041215000070 |
Provider Name | Jason T Cook |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1043283641 PECOS PAC ID: 7618928821 Enrollment ID: I20050204000566 |
Provider Name | Richard L Hite |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1124087036 PECOS PAC ID: 1052354461 Enrollment ID: I20050607000522 |
Provider Name | Jody D Dietsch |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1629324850 PECOS PAC ID: 8224069489 Enrollment ID: I20050826000732 |
Provider Name | Amanda L Mayle |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1003865395 PECOS PAC ID: 6406878628 Enrollment ID: I20051230000380 |
Provider Name | Anthony D Jeffers |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1467423863 PECOS PAC ID: 9032125976 Enrollment ID: I20060301000431 |
Provider Name | Jinny R Broderick |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1558441717 PECOS PAC ID: 8820191158 Enrollment ID: I20070307000226 |
Provider Name | Karen S Lothamer |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1699823492 PECOS PAC ID: 9830294545 Enrollment ID: I20070424000668 |
Provider Name | Ajaz Iqbal |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1477616753 PECOS PAC ID: 1254438112 Enrollment ID: I20070530000076 |
Provider Name | Syed Hasan |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1619909991 PECOS PAC ID: 6800782137 Enrollment ID: I20070619000008 |
Provider Name | Frank Shao |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1982683736 PECOS PAC ID: 1052494853 Enrollment ID: I20080218000368 |
Provider Name | Alan Breier |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1598924334 PECOS PAC ID: 6507938263 Enrollment ID: I20080712000103 |
Provider Name | Catherine A Duchovic |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1558444984 PECOS PAC ID: 8224104427 Enrollment ID: I20080912000321 |
Provider Name | Janet B Anderson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134379688 PECOS PAC ID: 7214097054 Enrollment ID: I20081124000305 |
Provider Name | Sandra J Klinker |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1710926225 PECOS PAC ID: 7012074651 Enrollment ID: I20090325000652 |
Provider Name | Sarah Byerley Harber |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1992938393 PECOS PAC ID: 4688710486 Enrollment ID: I20091008000305 |
Provider Name | Ahsan Mahmood |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1760458921 PECOS PAC ID: 8921047473 Enrollment ID: I20100519000617 |
Provider Name | Viann Grace Ellsworth |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1952378895 PECOS PAC ID: 8527198597 Enrollment ID: I20100617000839 |
Provider Name | Marjorie L Burns |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1053328260 PECOS PAC ID: 8123211406 Enrollment ID: I20101019000884 |
Provider Name | James Keifer |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1336329333 PECOS PAC ID: 1759576606 Enrollment ID: I20101117000660 |
Provider Name | Ina S Carlson |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1265490650 PECOS PAC ID: 0244425122 Enrollment ID: I20101117001044 |
Provider Name | Deborah S Baker |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467630061 PECOS PAC ID: 6406044734 Enrollment ID: I20101230000369 |
Provider Name | Ronald J Pancner |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1316980576 PECOS PAC ID: 0547291031 Enrollment ID: I20110520000119 |
Provider Name | Alicia A Elliott |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1699071100 PECOS PAC ID: 1759553225 Enrollment ID: I20111005000071 |
Provider Name | Laura M Folds |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306129283 PECOS PAC ID: 5496920936 Enrollment ID: I20111212000133 |
Provider Name | Richard Lamar Cain |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336410703 PECOS PAC ID: 7618102310 Enrollment ID: I20131106000267 |
Provider Name | Cyrus D Solhkhah |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1174710347 PECOS PAC ID: 0547249088 Enrollment ID: I20140114000743 |
Provider Name | Doris M Williams |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891966792 PECOS PAC ID: 3870776354 Enrollment ID: I20140707001744 |
Provider Name | Nicole A Deller |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114157641 PECOS PAC ID: 5193947141 Enrollment ID: I20141107000541 |
Provider Name | Brian Flesch |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1821043555 PECOS PAC ID: 3971815259 Enrollment ID: I20150629001835 |
Provider Name | Elizabeth A Pfeiffer |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1124252879 PECOS PAC ID: 6305065756 Enrollment ID: I20150827000975 |
Provider Name | Jenifer L Vohs |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1376823641 PECOS PAC ID: 6709183288 Enrollment ID: I20160329000210 |
Provider Name | Melinda Davis |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1093168718 PECOS PAC ID: 9638464019 Enrollment ID: I20160824001453 |
Provider Name | Rebecca Haynes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326577354 PECOS PAC ID: 5597035758 Enrollment ID: I20170720000752 |
Provider Name | Amanda Lowe |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1780093625 PECOS PAC ID: 8628336146 Enrollment ID: I20171211000902 |
Provider Name | Cynthia M Shepherd |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912435058 PECOS PAC ID: 4880952852 Enrollment ID: I20171220002120 |
Provider Name | Timothy Kowaleski |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1083093272 PECOS PAC ID: 2062724685 Enrollment ID: I20180523001656 |
Provider Name | Nicholas J Todoran |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1003369273 PECOS PAC ID: 8628325933 Enrollment ID: I20180718000987 |
Provider Name | Pamela Sue Thornton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609361062 PECOS PAC ID: 2567710619 Enrollment ID: I20180806001757 |
Provider Name | Andrea Hiyam Naaum |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1487071809 PECOS PAC ID: 0143510248 Enrollment ID: I20180810000287 |
Provider Name | Jessica Tullis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568951887 PECOS PAC ID: 5395095145 Enrollment ID: I20180829001579 |
Provider Name | Valerie J Rumple |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174706691 PECOS PAC ID: 7012260185 Enrollment ID: I20181019002049 |
Provider Name | Courtney L Washington |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1003121104 PECOS PAC ID: 4284987355 Enrollment ID: I20181019002104 |
Provider Name | Andrew Smith |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1295171734 PECOS PAC ID: 9537420245 Enrollment ID: I20181107002889 |
Provider Name | Amanda M Wyatt |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1811349335 PECOS PAC ID: 4082968128 Enrollment ID: I20181108001814 |
Provider Name | Evan Goodman |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1588107569 PECOS PAC ID: 9739423583 Enrollment ID: I20181205000199 |
Provider Name | Melodie A Gavin |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053725085 PECOS PAC ID: 3274877030 Enrollment ID: I20181205000290 |
Provider Name | Chelsea Crago |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1730557638 PECOS PAC ID: 0648514257 Enrollment ID: I20181210001364 |
Provider Name | Teresa L Roberts |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184911158 PECOS PAC ID: 0547504094 Enrollment ID: I20181210003201 |
Provider Name | Laura Michelle Oyer |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1356776025 PECOS PAC ID: 4587907506 Enrollment ID: I20190515000384 |
Provider Name | Caroline R Braun |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1497221691 PECOS PAC ID: 8729311469 Enrollment ID: I20190611002819 |
Provider Name | Sherri Sue Albertson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609437425 PECOS PAC ID: 9234464892 Enrollment ID: I20190718002060 |
Provider Name | Jasmine J Kaur |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1992113492 PECOS PAC ID: 4688891476 Enrollment ID: I20190822000781 |
Provider Name | Daniel Clayton Brewer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205497401 PECOS PAC ID: 2860720745 Enrollment ID: I20190830000869 |
Provider Name | Mahrokh Shayanpour |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1992120935 PECOS PAC ID: 7517239197 Enrollment ID: I20191004000896 |
Provider Name | Ambreen Ghori |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326458514 PECOS PAC ID: 5496046732 Enrollment ID: I20200116002797 |
Provider Name | Danielle R Allen |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1821528878 PECOS PAC ID: 6608204086 Enrollment ID: I20200318000903 |
Provider Name | Miranda Ellen Renee Kolde |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1477066538 PECOS PAC ID: 6901235837 Enrollment ID: I20200328000078 |
Provider Name | Megan Elizabeth Waters |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1568983443 PECOS PAC ID: 9739595992 Enrollment ID: I20210312001040 |
Provider Name | Kaitlyn J Chittick-myers |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1790301257 PECOS PAC ID: 8527475383 Enrollment ID: I20210324000767 |
Provider Name | Manpreet Khemka |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1457509903 PECOS PAC ID: 6709017072 Enrollment ID: I20210401000981 |
Provider Name | Deepak Khemka |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1396922977 PECOS PAC ID: 0345499927 Enrollment ID: I20210401001832 |
Provider Name | Nathan Reig Miner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932793478 PECOS PAC ID: 9739597154 Enrollment ID: I20210422002471 |
Provider Name | Rachel G Lilly |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1891223020 PECOS PAC ID: 5294085239 Enrollment ID: I20210629000163 |
Provider Name | Carmen Mae Stoller |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1215609821 PECOS PAC ID: 0941690168 Enrollment ID: I20211202001173 |
Provider Name | Cassandra G Winters |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1790326312 PECOS PAC ID: 4183005812 Enrollment ID: I20220713000519 |
Provider Name | Christianah Agunanne |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477212140 PECOS PAC ID: 8022493014 Enrollment ID: I20220912001491 |
Provider Name | Sheila Wolfrum |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194355982 PECOS PAC ID: 0345618955 Enrollment ID: I20221201000754 |
Provider Name | Sara Coburn |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861115750 PECOS PAC ID: 5395113989 Enrollment ID: I20221202000620 |
Provider Name | Corry Hawkins |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1841886884 PECOS PAC ID: 9133533995 Enrollment ID: I20221227000325 |
Provider Name | Kristen Alison Varian |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1639621766 PECOS PAC ID: 4385016088 Enrollment ID: I20230206002359 |
Provider Name | Ganit Anna Gray |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1215645551 PECOS PAC ID: 8820456163 Enrollment ID: I20230620001191 |
Provider Name | Chad R Percifield |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1629569140 PECOS PAC ID: 4880941178 Enrollment ID: I20230628000288 |
Provider Name | Sarah Michelle Moore |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003459561 PECOS PAC ID: 3072977230 Enrollment ID: I20230907000795 |
Provider Name | Akira Tsunawaki |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780395814 PECOS PAC ID: 0749635621 Enrollment ID: I20231012001677 |
Provider Name | Stacia Elizabeth Springer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306322177 PECOS PAC ID: 3476802760 Enrollment ID: I20231030002002 |
Provider Name | Sean P Andes |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1295096865 PECOS PAC ID: 5597113951 Enrollment ID: I20231122002459 |
Provider Name | Jacqueline Bondowski |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1679250252 PECOS PAC ID: 1850749219 Enrollment ID: I20231122002483 |
Provider Name | Lydia Elaine Hentz |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1952941908 PECOS PAC ID: 9234587601 Enrollment ID: I20231122002820 |
Provider Name | Jonathan Mayes |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1356733943 PECOS PAC ID: 9436507860 Enrollment ID: I20231127000800 |
Provider Name | Vanessa Michelle Hogan |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1508087842 PECOS PAC ID: 7517315948 Enrollment ID: I20231127000828 |
Provider Name | Laura R Murphy |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1861682114 PECOS PAC ID: 4587012927 Enrollment ID: I20231127001025 |
Provider Name | Wenyao Yu |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1720772023 PECOS PAC ID: 9537517982 Enrollment ID: I20231127001606 |
Provider Name | Kimberly K Smith |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1972789600 PECOS PAC ID: 5597113829 Enrollment ID: I20231128001398 |
Provider Name | Taylor Dawn Saunders |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1043869829 PECOS PAC ID: 8729436068 Enrollment ID: I20231128001925 |
Provider Name | Paige L Zehr |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1134731425 PECOS PAC ID: 4688027311 Enrollment ID: I20240130001735 |
Provider Name | Tabitha Frentz |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1700642659 PECOS PAC ID: 8325484405 Enrollment ID: I20240312000631 |
Provider Name | Jessica Gabbard |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1861146433 PECOS PAC ID: 2860839057 Enrollment ID: I20240323000319 |
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Christina Stapleton, L.l.c Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10315 Dawsons Creek Blvd # 12, Fort Wayne, IN 46825 Phone: 260-387-6340 | |
Oaktree Guidance & Wellness Center Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 Phone: 260-570-4515 Fax: 260-209-0762 | |
Courageous Healing Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2013 S Anthony Blvd, Fort Wayne, IN 46803 Phone: 260-417-4801 | |
Raj Clinics Professional Services Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 315 Airport North Office Park, Fort Wayne, IN 46825 Phone: 574-732-1166 Fax: 574-753-4117 | |
Sharon Mowrer Counseling And Consulting Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1415 Magnavox Way, Suite 120, Fort Wayne, IN 46804 Phone: 260-760-8645 | |
A.w. Holdings, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3900 Hursh Rd, Fort Wayne, IN 46845 Phone: 260-637-3608 |