{
"Npi": {
"NPI": "1326981614",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTREPID INSIGHTS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1800 HAZELWOOD AVE # 5719",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WAYNE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46805-7514",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "260-433-1651",
"MailingAddressFaxNumber": "866-305-9859",
"FirstLinePracticeLocationAddress": "116 E BERRY ST STE 1601",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WAYNE",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46802-2486",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "260-433-1651",
"PracticeLocationAddressFaxNumber": "866-305-9859",
"EnumerationDate": "04/11/2026",
"LastUpdateDate": "04/11/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUNYAN",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "260-433-0658",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084F0202X",
"TaxonomyName": "Forensic Psychiatry Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}