Alexander Porucznik

Primary specialty

SpecialistTaxonomy code 174400000X

License

10002834A Issued in IN

Practice address

1861 Sturdy Rd
Valparaiso, IN 46383-8017

Phone

(219) 548-0360

NPI assigned

Oct 14, 2019

Last updated

Apr 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Indiana University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Applegarth Dermatology PCGroup PAC ID 6305811514, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Applegarth Dermatology PC

  • Specialist
  • Valparaiso, IN
  • NPI 1619010626
  Medicare reassignment Care Compare group
• Applegarth Dermatology PC

  • Medical Physician Assistant
  • Valparaiso, IN
  • NPI 1982096822
  NPD (past)

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1952943649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 W QUINCY ST UNIT 617",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1861 STURDY RD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463838017",
            "telephone_number": "219-548-0360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6850 Centennial Dr",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604771653",
            "country_code": "US",
            "telephone_number": "708-429-3455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORUCZNIK",
        "first_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-14",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "10002834A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Porter-Starke Services, Inc.
• Glyn Anne Porter, M.D.
• Victoria Porter
• Porterfield Family Chiropractic PC
• Ryan Paul Porterfield, D.C.
• Gloria Rose Potter, LCSW
• Summer Pradke
• Rajat Prakash, MD
• Amy J Pratte, P.T.
• Premier Medical Supply Inc

• Specialist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.