Active NPI
Marc S Bruell, DPM
- Podiatrist
- Chesterton, IN
National Provider Identifier
1609874056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 0700687A
- Practice address
- 601 Gateway Blvd N
Chesterton, IN 46304-9658 - Phone
- (219) 921-1444
- Fax
- (219) 921-5303
- NPI assigned
- Jul 11, 2005
- Last updated
- Mar 19, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 0700687A | IN | Primary |
Addresses
Primary practice location
601 Gateway Blvd N
Chesterton, IN 46304-9658
Mailing address
601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | m.bruell@lbji.exscribedirect.com |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0700687A | IN | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dunes Optical, LLC | Past | Accepting new patients | |
| Medical Group Surgery Center LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Michigan City, IN
- NPI 1306943436
-
dba Healthpartners Medical Group Sugery Center
- Ambulatory Surgical Clinic/Center
- Michigan City, IN
- NPI 1760518617
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616112000000",
"number": "1609874056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 GATEWAY BLVD N",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463049658",
"telephone_number": "219-921-1444",
"fax_number": "219-921-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 GATEWAY BLVD N",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463049658",
"telephone_number": "219-921-1444",
"fax_number": "219-921-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUELL",
"first_name": "MARC",
"middle_name": "S",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2021-03-19",
"certification_date": "2021-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IN",
"license": "0700687A",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "m.bruell@lbji.exscribedirect.com",
"affiliation": "N",
"address_1": "601 Gateway Blvd N",
"city": "Chesterton",
"state": "IN",
"country_code": "US",
"postal_code": "463049658",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Chesterton, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.