Emilia M Kareem, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05011401A Issued in IN

Practice address

3221 Beacon Pkwy Ste 100
Granger, IN 46530-7196

Phone

(574) 647-2930

Fax

(574) 647-2935

NPI assigned

Jun 3, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Emilia M Ettl Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Beacon Health, LLC

  • Physical Therapist
  • Granger, IN
  • NPI 1386154821
  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • West Chester, OH
  • NPI 1174153266
  NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD
• Beacon Health, LLC

  • Diagnostic Radiology Physician
  • Goshen, IN
  • NPI 1952982217
  NPD (past)
• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1194138677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "746-471-6105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 BEACON PKWY STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465307196",
            "telephone_number": "574-647-2930",
            "fax_number": "574-647-2935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E Ireland Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-5790",
            "fax_number": "574-647-5792",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 E Jackson Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465163513",
            "country_code": "US",
            "telephone_number": "574-389-5558",
            "fax_number": "574-389-5559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 I St Ste 100",
            "address_purpose": "LOCATION",
            "city": "LA Porte",
            "state": "IN",
            "postal_code": "463505533",
            "country_code": "US",
            "telephone_number": "219-324-1730",
            "fax_number": "219-324-1735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAREEM",
        "first_name": "EMILIA",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05011401A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201230850",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekareem@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "3221 Beacon Pkwy Ste 100",
            "city": "Granger",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465307196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EMILIA",
            "last_name": "ETTL",
            "middle_name": "M",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bruce Joray, LCSW
• Jeanette Josol Jumao-As, PT
• Kelsey L Jurgonski, NP
• Katendi Kanema, APRN
• Melissa Elizabeth Karasek, LMT
• Alison Marie Kartz, HIS
• Kevin P Kaufhold, MD
• Shanna Verma Kautzmann, M.D.
• Hasaan Amer Kazi, MD
• Anna Keller, RBT

• Physical Therapist in Granger, IN
• Providers in Granger, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.