NPIMap

Organization Active NPI

Michiana Physical Medicine PC

  • Physical Therapist
  • Goshen, IN
National Provider Identifier
1336175769
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MICHIANA PHYSICAL MEDICINE PC
Practice address
1615 Winsted Dr
Suite 3
Goshen, IN 46526-4696
Phone
(574) 534-4648
NPI assigned
Jun 25, 2006
Last updated
Nov 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

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

Authorized official

Name
Dr. Joan SzynalNPI 1154422434
Title
Owner
Phone
(574) 534-4648

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1615 Winsted Dr
Suite 3
Goshen, IN 46526-4696

Mailing address

1615 Winsted Dr
Suite 3
Goshen, IN 46526-4696

Other identifiers 1

IdentifierTypeStateIssuer
200339920AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060106000024 IN Part B Supplier - Clinic/Group Practice 4486677432 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
Practice locations: Goshen, IN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1510 Osolo Rd
Elkhart, IN 46514
Phone (574) 266-6100

2240 Karisa Dr
Ste 3
Goshen, IN 46526
Phone (574) 534-4648

Practitioners & affiliated clinicians

Practitioners 12

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": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1336175769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 WINSTED DR",
            "address_2": "SUITE 3",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 WINSTED DR",
            "address_2": "SUITE 3",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264696",
            "telephone_number": "574-534-4648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA PHYSICAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "SZYNAL",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-534-4648",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200339920A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; 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.