Proteam Tactical Performance

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PROTEAM TACTICAL PERFORMANCE

Practice address

8025 Combs Rd
Indianapolis, IN 46237-9588

Phone

(317) 804-3501

NPI assigned

Nov 21, 2018

Organization subpart

No

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

Authorized official

Name

Joey Vandever

Title

Ceo

Phone

(317) 892-8180

Specialties & licenses 2

Addresses

Other identifiers 9

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stefanie L Bracken, PT, DPT

  • Physical Therapist
  • Fishers, IN
  • NPI 1316593841
  NPD (past)
• Kaylee A Ellis, DPT

  • Physical Therapist
  • Terre Haute, IN
  • NPI 1538724414
  NPD (past)
• Adam Grannan, DPT

  • Physical Therapist
  • Indianapolis, IN
  • NPI 1386371441
  NPD (past)

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

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1669941514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 E NORTHFIELD DR",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461122513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 COMBS RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462379588",
            "telephone_number": "317-804-3501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 N Post Rd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462195545",
            "country_code": "US",
            "telephone_number": "317-327-2047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 E 186th St",
            "address_purpose": "LOCATION",
            "city": "Westfield",
            "state": "IN",
            "postal_code": "460742001",
            "country_code": "US",
            "telephone_number": "317-804-3501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROTEAM TACTICAL PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-21",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "VANDEVER",
        "authorized_official_first_name": "JOEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-892-8180"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1639497795",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1750854873",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1366871915",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1871916783",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1891789418",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1396391918",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1407295181",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1336112135",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1417421793",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prospect Care Services
• Prospect Homecare Inc
• Prosperity Enrichment Inc.
• Elisabeth P Prosser, MD
• Prosthetic Technologies LLC
• Protected Provision Homecare LLC
• Stella Protopapas, MD, MPH
• Gretchen Sophia Prout
• John William Prout III, PHARMD
• Elizabeth J Proven, M.A., CCC-SLP

• Physical Medicine & Rehabilitation Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Medicine & Rehabilitation Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.