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JEFFERSON PEDIATRICS, PC
NPI 1134542855
Nurse Practitioner - Family in Fort Wayne, IN

Active since January 31, 2014CLIA 01D0692716 · Waiver
3919 W JEFFERSON BLVD, SUITE 1, FORT WAYNE, IN 46804(260) 436-7722 Get Directions Write a Review

NPPES record last updated: January 31, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jefferson Pediatrics, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFERSON PEDIATRICS, PC (NPI 1134542855) is a healthcare organization registered as a family in Fort Wayne, Indiana and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through October 13, 2027 and lists Giridhar Veerula, Physician, as its authorized official.

NPPES Registry Identity

NPI1134542855
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameJEFFERSON PEDIATRICS, PC
Location Address3919 W JEFFERSON BLVD, SUITE 1Fort Wayne, IN 46804-6811
Mailing Address3919 W Jefferson Blvd, Suite 1Fort Wayne, IN 46804-6811 · (260) 436-7722
Phone(260) 436-7722
Organization SubpartNo
Authorized OfficialGiridhar VeerulaPhysician · (260) 436-7722
Enumeration DateJanuary 31, 2014
✔ NPI 1134542855 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IN · 71004759A
3919 W JEFFERSON BLVD, Fort Wayne, IN 46804
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 01D0692716

Jefferson Pediatrics PC · Fort Wayne, IN
Active · expires Oct 13, 2027
CLIA Number01D0692716
Laboratory TypePhysician Office
Certificate Effective DateOctober 14, 2025
Certificate Expiration DateOctober 13, 2027
Laboratory DirectorGiridhar R. Veerula
Laboratory Phone(260) 436-7722
Laboratory LocationJefferson Pediatrics PC3919 W Jefferson Blvd Ste 1, Fort Wayne, IN 46804
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GIRIDHAR RAO VEERULA
Specialist
3919 W JEFFERSON BLVD
FORT WAYNE, IN 46804
Allen County (260) 436-7722
FORT WAYNE INTEGRATIVE MEDICINE
Internal Medicine
3919 W JEFFERSON BLVD
FORT WAYNE, IN 46804
Allen County (260) 475-0772
PEDSTAT
Clinic/Center (Urgent Care)
3919 W JEFFERSON BLVD, SUITE 2
FORT WAYNE, IN 46804
Allen County (260) 436-7722
BRITTANY LEE SCHOENLE PA
Physician Assistant
3919 W JEFFERSON BLVD
FORT WAYNE, IN 46804
Allen County (260) 436-7722
BERNITA FLYE
Nurse Practitioner (Pediatrics)
3919 W JEFFERSON BLVD
FORT WAYNE, IN 46804
Allen County (260) 436-7722
LISA MOELLERING RN, CPNP-PC
Nurse Practitioner (Pediatrics)
3919 W JEFFERSON BLVD
FORT WAYNE, IN 46804
Allen County (832) 482-8518

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jefferson Pediatrics, PC's NPI number?

The NPI number for Jefferson Pediatrics, PC is 1134542855. It was assigned to this organization in the NPPES registry on January 31, 2014.

Where is Jefferson Pediatrics, PC located?

Jefferson Pediatrics, PC is located at 3919 W Jefferson Blvd Suite 1, Fort Wayne, IN 46804. The listed phone number is (260) 436-7722.

What is Jefferson Pediatrics, PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Jefferson Pediatrics, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 01D0692716) is associated with this NPI, valid through October 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jefferson Pediatrics, PC was last updated on January 31, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.