NPIMap

Organization Active NPI

St Margaret Mercy Healthcare Centers, Inc.

Doing business as Lake Ridge Occupational Health

  • Family Medicine Physician
  • Griffith, IN
National Provider Identifier
1689746000
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST MARGARET MERCY HEALTHCARE CENTERS, INC.
Doing business as
Lake Ridge Occupational Health
Practice address
1573 N Cline Ave
Griffith, IN 46319-1567
Phone
(219) 838-2312
Fax
(219) 838-1521
NPI assigned
Nov 14, 2006
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Thomas Gryzbek
Title
President
Phone
(219) 932-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1573 N Cline Ave
Griffith, IN 46319-1567

Mailing address

PO Box 1000
Dyer, IN 46311-0800
Phone (219) 864-2107

Other identifiers 1

IdentifierTypeStateIssuer
0090000854OtherILBCBS GROUP NUMBER

Other names 1

  • Lake Ridge Occupational Health Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1689746000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463110800",
            "telephone_number": "219-864-2107",
            "fax_number": "219-864-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1573 N CLINE AVE",
            "city": "GRIFFITH",
            "state": "IN",
            "postal_code": "463191567",
            "telephone_number": "219-838-2312",
            "fax_number": "219-838-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARGARET MERCY HEALTHCARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "GRYZBEK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-932-2300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0090000854",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Ridge Occupational Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Griffith, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.

Verify at the official NPI Registry.