Great Lakes Orthopedics Physical Therapy P.C.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C.

Practice address

9615 Keilman St
Saint John, IN 46373-9406

Phone

(219) 365-0220

Fax

(219) 365-0226

NPI assigned

Mar 19, 2018

Last updated

Apr 13, 2018By 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

Keith PitchfordNPI 1568462729

Title

President/Ceo

Phone

(219) 365-0220

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 7

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.

• Felix Olusegun Odusaga, PT, DPT

  • Physical Therapist
  • Crown Point, IN
  • NPI 1396962056
  Medicare reassignment Care Compare group NPD
• Michael Pfeifer, DPT,ATC

  • Physical Therapist
  • Lowell, IN
  • NPI 1811226889
  Medicare reassignment Care Compare group
• Leolyn D Alburo, PT

  • Physical Therapist
  • Valparaiso, IN
  • NPI 1699734178
  Medicare reassignment
• Kristine Hepner, DPT

  • Physical Therapist
  • Crown Point, IN
  • NPI 1497295471
  Medicare reassignment
• Jaime Vander Zanden, DPT

  • Physical Therapist
  • Monee, IL
  • NPI 1982663373

  IN

  Medicare reassignment
• Keith R. Pitchford, D.O.

  • Orthopaedic Surgery Physician
  • Saint John, IN
  • NPI 1568462729
  NPD (past) Authorized official
• Robert Nicholas Weber, PT / ATC

  • Physical Therapist
  • Dearborn Heights, MI
  • NPI 1518994128
  NPD

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523577600000",
    "number": "1548764376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9615 KEILMAN ST",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739406",
            "telephone_number": "219-365-0220",
            "fax_number": "219-365-0226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 E Commercial Ave",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "IN",
            "postal_code": "463562310",
            "country_code": "US",
            "telephone_number": "219-696-6353",
            "fax_number": "219-696-6368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-04-13",
        "status": "A",
        "authorized_official_last_name": "PITCHFORD",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "219-365-0220"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana L Giordano
• Richard L Good, MD
• Tyler Gorman
• Ganapathi Gottumukkala, M.D.
• Great Lakes Orthopedics & Sports Medicine, PC
• Green Pediatrics LLC
• Cassandra Griffin
• Jessica Griffith
• Rebecca Gromala
• Nadim Hafez, MD

• Physical Therapist in Saint John, IN
• Providers in Saint John, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; 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.