NPIMap

Organization Active NPI

Otolaryngology Associates of Northwest Indiana LLC

  • Audiologist
  • Highland, IN
National Provider Identifier
1124782842
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
OTOLARYNGOLOGY ASSOCIATES OF NORTHWEST INDIANA LLC
Practice address
2211 Main St Ste 1a
Highland, IN 46322-3514
Phone
(219) 836-9368
Fax
(219) 836-9357
NPI assigned
Oct 28, 2021
Last updated
Jun 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Authorized official

Name
Bridget St. Pierre
Title
Office Manager
Phone
(219) 836-9368

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU
Diagnostic Radiology Physician 2085R0202X NU
Physical Therapist 225100000X NU
Audiologist 231H00000X NU Primary

Addresses

Primary practice location

2211 Main St Ste 1a
Highland, IN 46322-3514

Mailing address

2211 Main St Ste 1a
Highland, IN 46322-3514
Phone (219) 836-9368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220415000906 IN Part B Supplier - Clinic/Group Practice 0547656704 Receives reassigned benefits from 8 practitioners
Practice locations: Highland, IN

National Provider Directory

National Provider Directory

Locations

2211 Main St
Highland, IN 46322

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1124782842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 MAIN ST STE 1A",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463223514",
            "telephone_number": "219-836-9368",
            "fax_number": "219-836-9357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MAIN ST STE 1A",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463223514",
            "telephone_number": "219-836-9368",
            "fax_number": "219-836-9357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTOLARYNGOLOGY ASSOCIATES OF NORTHWEST INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-28",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "ST. PIERRE",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "219-836-9368"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.