Porter Physician Services LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PORTER PHYSICIAN SERVICES LLC

Practice address

3630 Willowcreek Rd
Portage, IN 46368-5075

Phone

(219) 759-5791

Fax

(219) 759-3807

NPI assigned

May 14, 2007

Last updated

Jan 28, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debbie T Brewer

Title

Director of Provider Enrollment

Phone

(615) 465-7626

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Porter Physician Services LLC

  • Orthopaedic Surgery Physician
  • Chesterton, IN
  • NPI 1285842963

  O20070810000409

  Same enrollment
• Porter Physician Services LLC

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1508075680

  O20070810000409

  Same enrollment

Locations

Practitioners 130

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.

• Kimberland Sharesh Anderson, M.D.

  • Family Medicine Physician
  • Munster, IN
  • NPI 1871738583
  NPD (past)
• James Praveen Anthony, MD

  • Pulmonary Disease Physician
  • Valparaiso, IN
  • NPI 1639356025

  Internal Medicine

  NPD (past)
• Krystal Antrim, FNP

  • Family Nurse Practitioner
  • La Porte, IN
  • NPI 1053191593
  NPD (past)
• Faleh Atassi, M.D.

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1346322393
  NPD (past)
• Jennifer Aversano, FNP

  • Family Nurse Practitioner
  • Valparaiso, IN
  • NPI 1568109254

  Family Medicine

  NPD (past)
• Helda Barakat, MD

  • Internal Medicine Physician
  • Valparaiso, IN
  • NPI 1154571529
  NPD (past)
• Paul Mitchell Bauer, MD

  • Trauma Surgery Physician
  • Fort Wayne, IN
  • NPI 1083697874
  NPD (past)
• Abigail Mae Boersma, FNP

  • Family Nurse Practitioner
  • Saint John, IN
  • NPI 1912540303
  NPD (past)
• Chad Anthony Bogue, NP

  • Family Nurse Practitioner
  • Portage, IN
  • NPI 1508411315
  NPD (past)
• Janice Marie Bohlim, NP

  • Family Nurse Practitioner
  • La Porte, IN
  • NPI 1821499328
  NPD (past)
• Ashley Bolen

  • Physician Assistant
  • Valparaiso, IN
  • NPI 1386582757
  NPD (past)
• Tiffany Bowen, NP

  • Family Nurse Practitioner
  • La Porte, IN
  • NPI 1750823795
  NPD (past)

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233100800000",
    "number": "1457566309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-759-5791",
            "fax_number": "219-759-3807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 WILLOWCREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685075",
            "telephone_number": "219-759-5791",
            "fax_number": "219-759-3807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTER PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2009-01-28",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portage Township Schools
• Porter Group Services, LLC
• Porter Health Services (Portage Medical Group)
• Porter Hospital LLC (Northwest Health-Porter)
• Porter Physician Services LLC (Porter Occupational Medicine)
• Porter Starke Services
• Porter-Starke Services Inc. (Marram Health Center Portage)
• Jamar Porter
• Marissa Powell
• Luis F Prato, LPT

• Internal Medicine Physician in Portage, IN
• Providers in Portage, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; 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.