| Rpinmd Llc | |
|
6326 Constitution Dr Fort Wayne IN 46804-1518 | |
| (260) 515-3275 | |
| (888) 803-6843 |
| Full Name | Rpinmd Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6326 Constitution Dr, Fort Wayne, Indiana |
| Authorized Official Name and Position | Chris Fountain (COO) |
| Authorized Official Contact | 2605153275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rpinmd Llc 6326 Constitution Dr Fort Wayne IN 46804-1518 Ph: (260) 515-3275 | Rpinmd Llc 6326 Constitution Dr Fort Wayne IN 46804-1518 Ph: (260) 515-3275 |
| NPI Number | 1710643085 |
|---|---|
| Provider Enumeration Date | 11/11/2021 |
| Last Update Date | 11/11/2021 |
| Medicare PECOS PAC ID | 4183014616 |
|---|---|
| Medicare Enrollment ID | O20211124000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710643085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Pamela Kinder Fountain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194955757 PECOS PAC ID: 3173651619 Enrollment ID: I20100504000806 |
| Provider Name | Eamonn M Keane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750558136 PECOS PAC ID: 7113195462 Enrollment ID: I20110713000047 |
| Provider Name | David A Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639178619 PECOS PAC ID: 9335194455 Enrollment ID: I20120720000159 |
| Provider Name | Alexa Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629472840 PECOS PAC ID: 9931426186 Enrollment ID: I20150326001888 |
| Provider Name | Andrew M Ellenwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689044117 PECOS PAC ID: 8325348444 Enrollment ID: I20151123000113 |
| Provider Name | Jennifer Dale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760833511 PECOS PAC ID: 5991060436 Enrollment ID: I20180604000599 |
| Provider Name | James Schrettenbrunner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437625803 PECOS PAC ID: 9032455167 Enrollment ID: I20190110003014 |
| Provider Name | Tiffany Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265169676 PECOS PAC ID: 3476929134 Enrollment ID: I20221020001423 |
| Provider Name | Joann Hobbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174165989 PECOS PAC ID: 3577974674 Enrollment ID: I20230207001352 |
| Provider Name | Mandy Vires |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023707171 PECOS PAC ID: 6709246366 Enrollment ID: I20230714002032 |
| Provider Name | Kyra Cooke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023619947 PECOS PAC ID: 5597908806 Enrollment ID: I20240309000324 |
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