JESSICA L. OTTENWELLER-BUTCHER (NPI# 1629089453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629089453 |
| Entity Type | Individual |
| Full Name | JESSICA L. OTTENWELLER-BUTCHER |
| Other Name | JESSICA L. OTTENWELLER |
| Credential | MD |
| Practice Address |
2516 E Dupont Rd Fort Wayne IN 46825-1608 |
| Mailing Address |
6920 Pointe Inverness Way Ste 200 Fort Wayne IN 46804-7934 |
| Practice Telephone | 2604583704 |
| Practice Fax Number | 2604583705 |
| Mailing Telephone | 2604793516 |
| Mailing Fax Number | 2604793520 |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-10-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01064357A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200941590 | 05 | |
| BLUE CROSS BLUE SHIELD | 000000615710 | 01 | |
| IN | RAILROAD MEDICARE | P01390392 | 01 |
| Street Address |
2516 E DUPONT RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46825-1608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538150404 | Allied Physicians Inc., D/b/a Tri-state Physical Medicine | Physical Medicine & Rehabilitation | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2005-10-31 |
| 1871154401 | Kimberly Million | Nurse Practitioner | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2019-06-25 |
| 1851813018 | Andrea Danielle Whitaker | Pharmacist | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2017-07-10 |
| 1013465152 | Nicole M Sanderson | Nurse Practitioner | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2016-09-19 |
| 1679934707 | Julea B. Diffenderfer | Dietitian, Registered | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2016-03-17 |
| 1073943387 | Kara Reyes | Physical Therapist | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2013-11-22 |
| 1659669513 | Lutheran Medical Group LLC | Durable Medical Equipment & Medical Supplies | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2011-07-13 |
| 1871738930 | Tiffany J. Bauman | Speech-Language Pathologist | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2008-12-03 |
| 1598808156 | Kristina R Leavell | Physician Assistant | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2007-02-14 |
| 1013927904 | Brian A. Adams | Family Medicine | 2516 E Dupont Rd, Fort Wayne, IN 46825-1608 | 2006-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
| 1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
| 1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
| 1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
| 1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
| 1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
| Find all providers in zip 46825 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760912026 | Christina A Tatara | Family Medicine | 6511 E State Blvd, Fort Wayne, IN 46815-7026 | 2017-06-19 |
| 1700317633 | Robert Campbell | Family Medicine | 7411 Hope Dr, Fort Wayne, IN 46815-5687 | 2017-03-22 |
| 1487196424 | American Vein Institute LLC | Family Medicine | 10020 Dupont Circle Ct Ste 140, Fort Wayne, IN 46825-1621 | 2016-11-08 |
| 1831547124 | Anna Menze | Family Medicine | 10307 Dupont Circle Dr W Ste A, Fort Wayne, IN 46825-1633 | 2016-05-27 |
| 1407203672 | Credo Health Group, LLC | Family Medicine | 10228 Dupont Circle Dr E # 100b, Fort Wayne, IN 46825-1611 | 2016-05-18 |
| 1649625104 | Gabrielle Paloma Acquaro | Family Medicine | 7806 W Jefferson Blvd Ste E, Fort Wayne, IN 46804-4180 | 2016-05-03 |
| 1720491731 | John E Marx | Family Medicine | 1007 W Rudisill Blvd, Fort Wayne, IN 46807-2170 | 2014-06-06 |
| 1457763252 | Amy Simpson | Family Medicine | 1818 Carew St Ste 120, Fort Wayne, IN 46805-4764 | 2014-05-28 |
| 1932536083 | Clifford James Shultz | Family Medicine | 2616 Covington Pointe Trl, Fort Wayne, IN 46804-2773 | 2013-10-03 |
| 1164860086 | Andrew J Mullally | Family Medicine | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 | 2013-06-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46825 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.