Northwest Indiana Podiatry Clinic, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

NORTHWEST INDIANA PODIATRY CLINIC, LLC

Practice address

3100 45TH Ave
Highland, IN 46322

Phone

(219) 922-0510

Fax

(219) 923-4594

NPI assigned

Jun 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Fortunee Massuda, DPM

Title

Medical Director & Ceo

Phone

(773) 233-3800

Specialties & licenses 7

Addresses

Other identifiers 2

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1609072677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 S WESTERN AVE",
            "address_2": "SUITE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431810",
            "telephone_number": "773-445-3800",
            "fax_number": "773-233-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 45TH AVE",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "46322",
            "telephone_number": "219-922-0510",
            "fax_number": "219-923-4594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST INDIANA PODIATRY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "MASSUDA",
        "authorized_official_first_name": "FORTUNEE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR & CEO",
        "authorized_official_telephone_number": "773-233-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "211D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "213EP0504X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200124730C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "90001145",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Highland, IN
• Providers in Highland, IN by specialty
• Foot & Ankle Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.