NPIMap

Individual provider Active NPI

Kevin Sison

  • Physical Therapist
  • Michigan City, IN
National Provider Identifier
1962973057
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05012372A Issued in IN
Practice address
3500 Franciscan Way
Michigan City, IN 46360-0021
Phone
(219) 877-1613
NPI assigned
Dec 16, 2018
Last updated
Aug 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05012372A IN Primary

Addresses

Primary practice location

3500 Franciscan Way
Michigan City, IN 46360-0021

Mailing address

2301 Dowling St
Valparaiso, IN 46385-7830
Phone (219) 510-2417

Other practice location 1

301 W Homer St
Michigan City, IN 46360-4358
Phone (219) 877-1613

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksison245770@Direct.FranciscanAlliance.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190429001991 IN Practitioner - Physical Therapist in Private Practice 3375885056 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

329 Rainbow Dr
Kokomo, IN 46902-3869
Phone (765) 400-2939

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Health Care Management LLC Physical Therapist CurrentSince Jan 1, 2022 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Aug 15, 2022 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Aug 15, 2022 Accepting new patients
Creative Health Care Management LLC Physical Therapist CurrentSince Jan 1, 2022 Accepting new patients

Locations

300 E Washington Blvd
Fort Wayne, IN 46802
Phone (260) 422-5511

10 S 9th St
Ste 4
Noblesville, IN 46060

101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436

Interoperability endpoints

  • Direct secure messaging: ksison245770@direct.franciscanalliance.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1962973057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 DOWLING ST",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463857830",
            "telephone_number": "219-510-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 FRANCISCAN WAY",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463600021",
            "telephone_number": "219-877-1613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 W Homer St",
            "address_purpose": "LOCATION",
            "city": "Michigan City",
            "state": "IN",
            "postal_code": "463604358",
            "country_code": "US",
            "telephone_number": "219-877-1613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISON",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-16",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05012372A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksison245770@Direct.FranciscanAlliance.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3500 Franciscan Way",
            "city": "Michigan City",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463600021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Michigan City, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.