NPIMap

Organization Active NPI

Great Lakes Orthopedics & Sports Medicine, PC

  • Orthopaedic Surgery Physician
  • Saint John, IN
National Provider Identifier
1669472270
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
02002102 Issued in IN
Legal business name
GREAT LAKES ORTHOPEDICS & SPORTS MEDICINE, PC
Practice address
9615 Keilman St
Saint John, IN 46373-9406
Phone
(219) 365-0220
Fax
(219) 365-0226
NPI assigned
Jul 26, 2005
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Keith R. Pitchford, DONPI 1568462729
Title
President/Ceo
Phone
(219) 365-0220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 02002102 IN Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 07001187A IN

Addresses

Primary practice location

9615 Keilman St
Saint John, IN 46373-9406

Mailing address

9615 Keilman St
Saint John, IN 46373-9406
Phone (219) 365-0220

Other practice location 1

1020 E Commercial Ave
Lowell, IN 46356-2310
Phone (219) 696-6353

Other identifiers 2

IdentifierTypeStateIssuer
90001186OtherILBC/BS IL
DC2442OtherINRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209001009 IN Part B Supplier - Clinic/Group Practice 2062306384 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Lowell, IN; Saint John, IN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10531/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1669472270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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 & SPORTS MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "PITCHFORD",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "219-365-0220",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "02002102",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07001187A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS IL",
            "identifier": "90001186",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC2442",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint John, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.