Individual provider Active NPI

Erika Pettis

  • Obstetrics & Gynecology Physician
  • La Porte, IN
National Provider Identifier
1093343170
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
1093343170 Issued in IN
Practice address
1509 State St
La Porte, IN 46350-3115
Phone
(219) 326-5700
NPI assigned
Apr 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X LA
Obstetrics & Gynecology Physician 207V00000X 1093343170 IN Primary

Addresses

Primary practice location

1509 State St
La Porte, IN 46350-3115

Mailing address

1509 State St
La Porte, IN 46350-3115
Phone (219) 326-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240919002743 IN Practitioner - Obstetrics/Gynecology 1951721323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of South Carolina School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Porte Clinic Company LLCGroup PAC ID 0446558357, 66 clinicians

Practice addresses (Care Compare)

104 E Culver Rd
Knox, IN 46534-2241

1331 State St
La Porte, IN 46350-3112

1509 State St
La Porte, IN 46350-3115
Phone (219) 326-5700

85 E US Hwy 6
Valparaiso, IN 46383-8947
Phone (219) 878-3217

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.68 of 100Reported as apm
Quality
76.2
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1093343170INMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Porte Clinic Company LLC CurrentSince Nov 1, 2024 Accepting new patients
La Porte Clinic Company LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

104 E Culver Rd
Ste 105
Knox, IN 46534
Phone (574) 772-7300

104 E Culver Rd
Ste 102
Knox, IN 46534
Phone (574) 772-1580

1509 State St
Laporte, IN 46350
Phone (219) 324-3431

3777 N Frontage Rd
Ste 600
Michigan City, IN 46360
Phone (219) 877-3841

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1093343170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 STATE ST",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503115",
            "telephone_number": "219-326-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 STATE ST",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503115",
            "telephone_number": "219-326-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "ERIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-01",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "1093343170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Porte, IN

Sources for this page

Verify at the official NPI Registry.