Individual ProviderThiyagarajan GaneshInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701(260) 266-2020(260) 266-8210PECOS EnrollmentBased on the most recent information from CMS, provider Thiyagarajan Ganesh is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1174771604Provider TypeIndividualFull NameGanesh, ThiyagarajanCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date9/9/2008Last Updated9/30/2019Contact InformationPractice LocationPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701Phone(260) 266-2020Fax(260) 266-2009Mailing LocationMailing Address3702 New Vision Dr, Ste B, Fort Wayne, IN 46845-1703Phone(260) 266-8210FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense01065538AIndianaCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense01065538AIndianaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense01065538AIndianaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense83287GeorgiaProvider IdentifiersIDDescriptionIssuerID000000588059DescriptionOtherIssuerANTHEMIndianaIDP00664354DescriptionOtherIssuerMEDICARE RAILROADIndianaID200197150DescriptionMedicaidIssuerUnlistedIndiana