Credo Health Group, LLC
NPI 1407203672ActiveOrganization· Family Medicine· Fort Wayne, IN
Family Medicine in Fort Wayne, Indiana, registered in NPPES in May 2016. The authorized official on file is Andrew J. Mullally, M.D., Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1407203672 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 18, 2016 |
| Last updated in NPPES | Feb 14, 2025 |
| Certified by provider | Feb 10, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | 01074259A | IN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IN) |
|---|
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