NPIMap

Organization Active NPI

Indiana University Health Lakeshore Surgicare LLC

  • Ambulatory Surgical Clinic/Center
  • Chesterton, IN
National Provider Identifier
1427373679
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
13-011186-1 Issued in IN
Legal business name
INDIANA UNIVERSITY HEALTH LAKESHORE SURGICARE LLC
Practice address
3111 Village Pointe
Chesterton, IN 46304-9689
Phone
(219) 983-1401
Fax
(219) 929-1408
NPI assigned
Mar 31, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

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

Authorized official

Name
Mr. Gudsteinn T Thordarson, N/A
Title
President
Phone
(219) 326-2555

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X IN
Ambulatory Surgical Clinic/Center 261QA1903X 13-011186-1 IN Primary

Addresses

Primary practice location

3111 Village Pointe
Chesterton, IN 46304-9689

Mailing address

3111 Village Pointe
Chesterton, IN 46304-9689
Phone (219) 983-1401

Other identifiers 3

IdentifierTypeStateIssuer
10-011186-1OtherINASC LICENSE
M300021861OtherINMEDICARE PTAN
200990180 AMedicaidIN

Other names 1

  • CNI SURGICARE LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

3111 Village Pt
Chesterton, IN 46304
Phone (219) 983-1401

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1427373679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 VILLAGE POINTE",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049689",
            "telephone_number": "219-983-1401",
            "fax_number": "219-929-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 VILLAGE POINTE",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049689",
            "telephone_number": "219-983-1401",
            "fax_number": "219-929-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH LAKESHORE SURGICARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-31",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "THORDARSON",
        "authorized_official_first_name": "GUDSTEINN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-326-2555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IN",
            "license": "13-011186-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC LICENSE",
            "identifier": "10-011186-1",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M300021861",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200990180 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CNI SURGICARE LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chesterton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.