Active NPI
Adam Lee Waugh, MPO, CO
- Orthotist
- South Bend, IN
National Provider Identifier
1487176293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- 213.000354
- Practice address
- 17530 Dugdale Dr
South Bend, IN 46635-1583 - Phone
- (574) 233-3352
- NPI assigned
- Jul 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | 213.000354 | IL | Primary |
Addresses
Primary practice location
17530 Dugdale Dr
South Bend, IN 46635-1583
Mailing address
17530 Dugdale Dr
South Bend, IN 46635-1583
Phone (574) 233-3352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213.000354 | IL | MD | Orthotist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499904000000",
"number": "1487176293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17530 DUGDALE DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351583",
"telephone_number": "574-233-3352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17530 DUGDALE DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351583",
"telephone_number": "574-233-3352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAUGH",
"first_name": "ADAM",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "MPO, CO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-13",
"last_updated": "2017-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Orthotist",
"state": "IL",
"license": "213.000354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.