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

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

Other identifiers 1

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 (25 of 31)

Practitioners 134

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

• Kimberland Sharesh Anderson, M.D.

  • Family Medicine Physician
  • Munster, IN
  • NPI 1871738583

  Family Medicine

  NPD (past)
• James Praveen Anthony, MD

  • Pulmonary Disease Physician
  • Valparaiso, IN
  • NPI 1639356025

  Internal Medicine

  NPD (past)
• Krystal Antrim, FNP

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

  • Family Medicine Physician
  • Valparaiso, IN
  • NPI 1346322393

  Family Medicine

  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

  Internal Medicine

  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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200866880A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Portage Township Schools
• Porter Group Services, LLC
• Porter Health Services
• Porter Hospital LLC
• Porter Physician Services LLC
• Porter Starke Services
• Porter-Starke Services Inc.
• Jamar Porter
• Marissa Powell
• Luis F Prato, LPT

• All providers in Portage, IN
• 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.