LUTHERAN MEDICAL GROUP LLC NPI 1164662805

NPI Information

NPI: 1164662805
Provider Name: LUTHERAN MEDICAL GROUP LLC
Classification: Internal Medicine - 207RC0000X
Entity Type: Organization

Specialization: Cardiovascular Disease

CLIA Number: 15D2097335

Address:
7916 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804
Phone: (260) 432-2297
Get Directions

LUTHERAN MEDICAL GROUP LLC is a cardiovascular disease internal medicine in Fort Wayne, IN. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. LUTHERAN MEDICAL GROUP LLC NPI is 1164662805. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7916 W JEFFERSON BLVD
FORT WAYNE, IN
ZIP 46804-140
Phone: (260) 432-2297

The provider's authorized official is Kristina Music .
The authorized official title is Director, Provider Enrollment and has the following contact phone number (877) 892-9815.

The CLIA number assigned to this NPI record is 15D2097335 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/20/2009 and was last updated on 3/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207R00000X	Internal Medicine		No
2	207RA0201X	Internal Medicine	Allergy & Immunology	No
3	207RC0000X	Internal Medicine	Cardiovascular Disease	Yes
4	207RC0001X	Internal Medicine	Clinical Cardiac Electrophysiology	No
5	207RP1001X	Internal Medicine	Pulmonary Disease	No
6	207RR0500X	Internal Medicine	Rheumatology	No
7	207RS0012X	Internal Medicine	Sleep Medicine	No
8	207UN0901X	Nuclear Medicine	Nuclear Cardiology	No
9	363A00000X	Physician Assistant		No
10	363L00000X	Nurse Practitioner		No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200934510	MEDICAID	INDIANA
2	2938843	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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