Active NPI
Deborah Anne Surface, OTR
- Occupational Therapist
- Michigan City, IN
National Provider Identifier
1659449080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 310000932A
- Practice address
- 431 Boyd Cir
Michigan City, IN 46360-7022 - Phone
- (219) 873-3696
- Fax
- (219) 872-1938
- NPI assigned
- Dec 2, 2006
- Last updated
- Apr 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 310000932A | IN | Primary |
| Occupational Therapist | 225X00000X | 056008095 | IL |
Addresses
Primary practice location
431 Boyd Cir
Michigan City, IN 46360-7022
Mailing address
431 Boyd Cir
Michigan City, IN 46360-7022
Phone (219) 873-3696
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09932114 | Other | IL | BCBS |
| 200655000 | Medicaid | IN | |
| 2187460 | Other | IN | UNITED HEALTHCARE |
| 000000095746 | Other | IN | BLUE CROSS BLUE SHIELD |
| 200043890 | Medicaid | IN | |
| 2007148410A | Medicaid | IN |
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 |
|---|---|---|---|
| 056008095 | IL | MD | Occupational Therapist |
| 310000932A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1659449080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "431 BOYD CIR",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463607022",
"telephone_number": "219-873-3696",
"fax_number": "219-872-1938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 BOYD CIR",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463607022",
"telephone_number": "219-873-3696",
"fax_number": "219-872-1938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURFACE",
"first_name": "DEBORAH",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-02",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "310000932A",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056008095",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "09932114",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200655000",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2187460",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000000095746",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200043890",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2007148410A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
- Faye Christine Stokes, D.D.S.
- Thomas C. Stokes II, D.D.S.
- Sarah Jane Strahm, NP
- Scott D Strandberg, DPT
- Superior Family Health Services, Corp.
- Jessica Ann Surma, RN, FNP-C
- Swanson Center (LaPorte County Mental Health Council)
- Christopher Joseph Swistek, LCSW
- Jason Preston Tackett, NP-C
- Tamara Eaton DDS PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.