NPIMap

Organization Active NPI

Crossroads Medical Corporation

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Valparaiso, IN
National Provider Identifier
1376775718
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
CROSSROADS MEDICAL CORPORATION
Practice address
3028 Calumet Ave
Valparaiso, IN 46383-2640
Phone
(219) 477-6888
Fax
(219) 477-6804
NPI assigned
Aug 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Authorized official

Name
Mrs. Martine S Bergeron
Title
President
Phone
(219) 477-6888

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary

Addresses

Primary practice location

3028 Calumet Ave
Valparaiso, IN 46383-2640

Mailing address

3028 Calumet Ave
Valparaiso, IN 46383-2640
Phone (219) 477-6888

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Medical Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1376775718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3028 CALUMET AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832640",
            "telephone_number": "219-477-6888",
            "fax_number": "219-477-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3028 CALUMET AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832640",
            "telephone_number": "219-477-6888",
            "fax_number": "219-477-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "MARTINE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-477-6888",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; 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.