PEDIATRIC & ADULT ALLERGY ASTHMA & IMMUNOLOGY SPECIALISTS, LLC (NPI# 1790801512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790801512 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC & ADULT ALLERGY ASTHMA & IMMUNOLOGY SPECIALISTS, LLC |
| Practice Address |
3030 Lake Ave Suite 27 Fort Wayne IN 46805-5428 |
| Practice Telephone | 2604225569 |
| Practice Fax Number | 2604226086 |
| Mailing Telephone | 2604225569 |
| Mailing Fax Number | 2604226086 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MONICA S NELSON (BUSINESS MANAGER) |
| Authorized Official Telephone | 2604225569 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians |
| Street Address |
3030 LAKE AVE SUITE 27 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073507745 | Thomas P Van Den Driessche | Family Medicine | 3030 Lake Ave, Suite32, Fort Wayne, IN 46805-5428 | 2005-09-08 |
| 1417494170 | Linzie Tuck | Behavioral Analyst | 3030 Lake Ave, Suite 20, Fort Wayne, IN 46805-5428 | 2017-01-19 |
| 1447587696 | Indiana Endocrine Specialist, LLC | Clinic/Center | 3030 Lake Ave, Suite 17, Fort Wayne, IN 46805-5428 | 2009-11-09 |
| 1225204613 | Marilyn Arlene Nathan | Psychologist | 3030 Lake Ave, Fort Wayne, IN 46805-5428 | 2008-05-05 |
| 1538349956 | Thomas P Van Den Driessche | Family Medicine | 3030 Lake Ave, Suite 32, Fort Wayne, IN 46805-5428 | 2007-11-14 |
| 1417156456 | Nora Marie Stewart | Audiologist-Hearing Aid Fitter | 3030 Lake Ave, Suite 23, Fort Wayne, IN 46805-5428 | 2007-07-11 |
| 1093916959 | Little Turtle Pediatrics, P.C. | Pediatrics | 3030 Lake Ave, Suite 10, Fort Wayne, IN 46805-5428 | 2007-05-29 |
| 1780899096 | Michael Joseph Luarde | Dentist | 3030 Lake Ave, Suite 19, Fort Wayne, IN 46805-5428 | 2007-05-11 |
| 1093938102 | Interdisciplinary Diagnostic and Evaluation Center, Inc. | Clinic/Center | 3030 Lake Ave, Suite 7, Fort Wayne, IN 46805-5428 | 2007-04-10 |
| 1568595999 | Pediatrics Center of Fort Wayne, P.C. | Pediatrics | 3030 Lake Ave, #25a, Fort Wayne, IN 46805-5428 | 2007-03-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
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| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255561767 | Adam Updegraff | Allergy & Immunology | 7964 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2009-07-17 |
| 1407096167 | Summit Allergy Inc | Allergy & Immunology | 7030 Pointe Inverness Way Ste 335, Fort Wayne, IN 46804-7929 | 2009-02-20 |
| 1386606911 | The Allergy & Asthma Center, P.C. | Allergy & Immunology | 7222 Engle Road, Fort Wayne, IN 46804-2222 | 2006-04-06 |
| 1689714727 | Fort Wayne Allergy and Asthma Consultants, Inc. | Allergy & Immunology | 7920 W Jefferson Blvd, Suite 220, Fort Wayne, IN 46804-4168 | 2007-02-07 |
| 1346320504 | Drs. Nelson & Menon | Allergy & Immunology | 3030 Lake Ave, Suite 27, Fort Wayne, IN 46805-5428 | 2006-10-16 |
| 1851491377 | Mohan M Menon | Allergy & Immunology | 3030 Lake Ave, Suite 27, Fort Wayne, IN 46805-5428 | 2006-09-24 |
| 1437259967 | James B Nelson | Allergy & Immunology | 3030 Lake Ave, Suite 27, Fort Wayne, IN 46805-5428 | 2006-09-24 |
| 1871556951 | Russell Vaughn Maples | Allergy & Immunology | 7222 Engle Road, Fort Wayne, IN 46804-2222 | 2006-04-10 |
| 1811950462 | William Lee Smits | Allergy & Immunology | 7222 Engle Road, Fort Wayne, IN 46804-2222 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538613211 | Allergy Partners, Pa | Allergy & Immunology | 100 N Curry Pike Ste 3, Bloomington, IN 47404-2593 | 2016-08-10 |
| 1225468937 | Deaconess Clinic, Inc | Allergy & Immunology | 4840 S Maple Tree Dr, Princeton, IN 47670-9277 | 2013-11-15 |
| 1285977033 | Vivian Cruz Nanagas | Allergy & Immunology | 4400 Weston Pointe Dr Ste 150, Zionsville, IN 46077 | 2013-03-30 |
| 1881946390 | Allergy Partners, Pllc | Allergy & Immunology | 9002 N Meridian St Ste 107, Indianapolis, IN 46260-5349 | 2012-10-08 |
| 1588827562 | Jennifer Ann Rumpel | Allergy & Immunology | 6375 Us Highway 6 Ste C, Portage, IN 46368 | 2008-07-09 |
| 1083895916 | Paul D. Isenberg, M.d. Inc. | Allergy & Immunology | 1340 E. County Line Rd., Suite T, Indianapolis, IN 46227 | 2007-11-20 |
| 1174732804 | Nabeel N Farooqui | Allergy & Immunology | 11501 Cumberland Rd Ste 500, Fishers, IN 46037-7010 | 2007-05-21 |
| 1740494079 | Allergy Associates PC | Allergy & Immunology | 815 Schnier Street, Columbus, IN 47201-2619 | 2007-05-09 |
| 1497968366 | Nathan Boone Richards | Allergy & Immunology | 3003 Charlestown Xing, Suite D, New Albany, IN 47150-8302 | 2007-05-08 |
| 1104850718 | Allergy Associates of Central In | Allergy & Immunology | 6845 East Us 36, Suite 710, Avon, IN 46123 | 2006-07-10 |
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| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on PEDIATRIC & ADULT ALLERGY ASTHMA & IMMUNOLOGY SPECIALISTS, LLC.
| 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.