Summit City Prosthetics & Orthotics Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

SUMMIT CITY PROSTHETICS & ORTHOTICS INC

Practice address

16597 State Road 23 Ste 2
South Bend, IN 46635-1461

Phone

(574) 855-1488

Fax

(574) 387-5583

NPI assigned

Apr 19, 2021

Organization subpart

Yes

Parent organization

SUMMIT CITY PROSTHETICS & ORTHOTICS, INCAs reported in NPPES

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

Authorized official

Name

Mr. Shawn Dee Brown, CPONPI 1184156101

Title

President

Phone

(260) 312-1746

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Summit City Prosthetics Orthotics Inc2 organizations share this tax ID, including this one

Part of

Summit City Prosthetics Orthotics Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Summit City Prosthetics & Orthotics Inc

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
  • NPI 1043866106
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Summit City Prosthetics & Orthotics Inc

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
  • NPI 1043866106
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Dee Brown, CPO

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
  • NPI 1184156101
  NPD Authorized official

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1184205379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16597 STATE ROAD 23 STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351461",
            "telephone_number": "574-855-1488",
            "fax_number": "574-387-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16597 STATE ROAD 23 STE 2",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351461",
            "telephone_number": "574-855-1488",
            "fax_number": "574-387-5583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT CITY PROSTHETICS & ORTHOTICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT CITY PROSTHETICS & ORTHOTICS, INC",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-312-1746",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300033323",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordynn Sudderth
• Bridgett C Suddon
• Bryanna Suggs, RBT
• Elizabeth Anne Sullivan, OT
• Joan M Sullivan, MA
• Summit Counseling Services PC
• Gary Masao Sunada, M.D.
• Rajalakshmy Sundararajan, MD
• Julie Ann Sunday, DPT
• Sunnyside Pediatric Therapy LLC

• Prosthetic/Orthotic Supplier in South Bend, IN
• Providers in South Bend, IN by specialty
• Prosthetic/Orthotic Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.