Great Lakes Anesthesia, P.C.
Organization Active NPI Anesthesiology Physician · Elkhart, IN
NPI 1720039977 · NPPES record last updated Nov 6, 2024
Key facts
- NPI
- 1720039977
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Seth Claxton, CRNA
- Title
- Ceo
- Phone
- (574) 522-9922
Practitioners 122
-
Robert Colcord, CRNA
-
Linda L Fleming, CRNA
-
Roni Aizigov, CRNA, NP-C
-
Leanne P Behny, C.R.N.A.
-
Dee Ann Berry, CRNA
-
Jay Biesenthal, CRNA
-
Paul Bojrab, MD
-
Nicole Borem Schickel, CRNA
-
Eric Brewer, CRNA
-
Elena Chance, CRNA
-
Seth Michael Claxton, CRNA
-
Jamie Ann Davidson, CRNA
-
Marcus Lynn Ebright Zehr, CRNA
-
Thaddeus Herman, CRNA
-
Julie J Jarrett, CRNA
-
William Anthony Jones, CRNA
-
Barbara E Larson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
1004 Parkway Ave
Ste B
Elkhart, IN 46516
Phone (219) 309-8149
700 E Beardsley Ave
Ste 209
Elkhart, IN 46514
1004 Parkway Ave
Ste A
Elkhart, IN 46516
Phone (800) 966-7841
56218 Parkway Ave
Ste B
Elkhart, IN 46516
Phone (574) 293-0005
500 N Nappanee St
Ste 11B
Elkhart, IN 46514
11420 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 482-5194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| Certified Registered Nurse Anesthetist |
367500000X | IN |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200250870 | Medicaid | IN |
Other providers in Elkhart, IN
- Starla D Graber
- Graceful Came in Home LLC
- Graceful Came in Home LLC
- Tatiana Vasilievna Graham
- Nicole R Graves
- Martina A Green-McGowan
- Denise E Green
- Joy Greeney
- Greenleaf Family Dentistry
- Clayton Greer
All providers in Elkhart, IN · Anesthesiology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.