NPIMap

Organization Active NPI

Great Lakes Anesthesia, P.C.

  • Anesthesiology Physician
  • Elkhart, IN
National Provider Identifier
1720039977
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
GREAT LAKES ANESTHESIA, P.C.
Practice address
700 E Beardsley Ave Ste 209
Elkhart, IN 46514-3371
Phone
(574) 522-9922
Fax
(574) 522-9926
NPI assigned
May 12, 2006
Last updated
Nov 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Mr. Seth Claxton, CRNANPI 1801198395
Title
Ceo
Phone
(574) 522-9922

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
Certified Registered Nurse Anesthetist 367500000X IN
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

700 E Beardsley Ave Ste 209
Elkhart, IN 46514-3371

Mailing address

PO Box 2147
Elkhart, IN 46515-2147
Phone (574) 522-9922

Other identifiers 1

IdentifierTypeStateIssuer
200250870MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000452 IN Part B Supplier - Clinic/Group Practice 0648183442 Receives reassigned benefits from 60 practitioners
Practice locations: Huntington, IN; Elkhart, IN; Kendallville, IN; Lagrange, IN; Marion, IN; Mishawaka, IN; Plymouth, IN; Rochester, IN…
O20041115001189 IN Part B Supplier - Clinic/Group Practice 0648183442 Receives reassigned benefits from 16 practitioners
Practice locations: Columbia City, IN; Winamac, IN; Rochester, IN; Plymouth, IN; Mishawaka, IN; Marion, IN; Lagrange, IN; Kendallville, IN…

National Provider Directory

National Provider Directory

Locations

1004 Parkway Ave
Ste A
Elkhart, IN 46516
Phone (800) 966-7841

1004 Parkway Ave
Ste B
Elkhart, IN 46516
Phone (219) 309-8149

500 N Nappanee St
Ste 11B
Elkhart, IN 46514

56218 Parkway Ave
Ste B
Elkhart, IN 46516
Phone (574) 293-0005

700 E Beardsley Ave
Ste 209
Elkhart, IN 46514

11192 Diebold Rd
Fort Wayne, IN 46845
Phone (260) 483-9500

11420 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 482-5194

7900 W Jefferson Blvd
Ste 304
Fort Wayne, IN 46804
Phone (260) 435-6200

611 E Douglas Rd
Ste 108
Mishawaka, IN 46545
Phone (574) 968-3515

Practitioners & affiliated clinicians

Practitioners 121

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 121

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1720039977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152147",
            "telephone_number": "574-522-9922",
            "fax_number": "574-522-9926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E BEARDSLEY AVE STE 209",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143371",
            "telephone_number": "574-522-9922",
            "fax_number": "574-522-9926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ANESTHESIA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "CLAXTON",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-522-9922",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200250870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.