NPIMap

Organization Active NPI

Crossroads Medical Corporation

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Merrillville, IN
National Provider Identifier
1801123583
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
CROSSROADS MEDICAL CORPORATION
Practice address
403 W 81St Ave
Merrillville, IN 46410-5317
Phone
(219) 756-6600
Fax
(219) 756-6602
NPI assigned
Nov 17, 2009
Last updated
Nov 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

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

Authorized official

Name
Martine S Bergeron
Title
President
Phone
(219) 756-6600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU Primary

Addresses

Primary practice location

403 W 81St Ave
Merrillville, IN 46410-5317

Mailing address

403 W 81St Ave
Merrillville, IN 46410-5317
Phone (219) 756-6600

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Medical Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1801123583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W 81ST AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105317",
            "telephone_number": "219-756-6600",
            "fax_number": "219-756-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W 81ST AVE",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105317",
            "telephone_number": "219-756-6600",
            "fax_number": "219-756-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "MARTINE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-756-6600"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.