Great Lakes Orthotics & Prosthetics Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

GREAT LAKES ORTHOTICS & PROSTHETICS INC.

Practice address

3950 Evergreen CT Ste a
Appleton, WI 54913-8903

Phone

(920) 968-2240

Fax

(920) 968-2241

NPI assigned

Jun 17, 2006

Organization subpart

No

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

Authorized official

Name

Perry L Alger, CO

Title

President

Phone

(920) 968-2240

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1720023724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 EVERGREEN CT STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138903",
            "telephone_number": "920-968-2240",
            "fax_number": "920-968-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 EVERGREEN CT STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138903",
            "telephone_number": "920-968-2240",
            "fax_number": "920-968-2241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORTHOTICS & PROSTHETICS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "ALGER",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-968-2240",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41792000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie L Grant, LMT
• Elizabeth Rose Graser, BCBA
• Jessie M Grasse, NP
• Clarissa Mae Grathen, LPC-IT
• Sharon L Gray, PSYCHOLOGIST
• Amie Anna Lee Greely, PTA
• Green Meadows Senior Living LLC
• Bernard L Green, PH D
• Gearin A Green, M.D.
• Nicole Green, RPH

• Prosthetic/Orthotic Supplier in Appleton, WI
• Providers in Appleton, WI by specialty
• Prosthetic/Orthotic Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.