EAR, NOSE & THROAT ASSOCIATES, PC — NPI 1619954468 (Licensed & Credentialed Allopathic & Osteopathic Physicians

CMS-1500 Box 24J / 33a • NPI

1619954468

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207Y00000X (CMS 04)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology

Box 32 Service Location & ZIP+4

1169 N MAIN ST, SUITE 5, BLUFFTON, IN, 46714-1360

✓ 9-Digit EDI 837 ZIP+4 (46714-1360)

Practice Phone & Referral Fax

(260) 827-4368

Fax: (260) 827-4370

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1619954468 (EAR, NOSE & THROAT ASSOCIATES, PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1619954468` (NPI-2 Organization / Facility)
Provider / Legal Name	EAR, NOSE & THROAT ASSOCIATES, PC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology NUCC Code: `207Y00000X` (Otolaryngology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1169 N MAIN ST, SUITE 5, BLUFFTON, IN, 46714-1360
Practice Telephone / Fax	Tel: (260) 827-4368 \| Fax: (260) 827-4370
Administrative Mailing Address	10021 DUPONT CIRCLE CT, FORT WAYNE, IN, 46825-1604
Enumeration & Last Sync	Enumerated: 2005-12-22 \| CMS Record Updated: 2020-08-22
Authorized Official	KENN VAN DER WEELE (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1169 N MAIN ST, SUITE 5, BLUFFTON, IN, 46714-1360

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Plain-English Taxonomy & CMS Crosswalk (207Y00000X)

What Does Taxonomy Code 207Y00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207Y00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 04 (Physician/Otolaryngology)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Otolaryngology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EAR, NOSE & THROAT ASSOCIATES, PC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207Y00000X` — Otolaryngology Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology	State: IN \| License: `50000001A` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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EAR, NOSE & THROAT ASSOCIATES, PC (NPI #1619954468)