NPIMap

Organization Active NPI

Lake-Porter Cardiovascular PC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Valparaiso, IN
National Provider Identifier
1972694669
Registry record updated Dec 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
50000940A Issued in IN
Legal business name
LAKE-PORTER CARDIOVASCULAR PC
Practice address
2000 Roosevelt Rd Ste 101
Valparaiso, IN 46383-2801
Phone
(219) 462-1619
Fax
(219) 548-0867
NPI assigned
Sep 27, 2006
Last updated
Dec 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2019

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

Authorized official

Name
Marcia Powers
Title
Office Manager
Phone
(219) 477-4452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 50000940A IN Primary

Addresses

Primary practice location

2000 Roosevelt Rd Ste 101
Valparaiso, IN 46383-2801

Mailing address

2000 Roosevelt Rd Ste 101
Valparaiso, IN 46383-2801
Phone (219) 462-1619

Other practice location 1

8687 Connecticut St
Ste F
Merrillville, IN 46410-6361
Phone (219) 769-7800

Other identifiers 1

IdentifierTypeStateIssuer
100141870AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050831000730 IN Part B Supplier - Clinic/Group Practice 6406888379 Receives reassigned benefits from 3 practitioners
Practice locations: Laporte, IN; Merrillville, IN; Valparaiso, IN

National Provider Directory

National Provider Directory

Locations

8687 Connecticut St
Ste F
Merrillville, IN 46410
Phone (219) 525-4176

2000 Roosevelt Rd
Ste 101
Valparaiso, IN 46383
Phone (219) 462-1619

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1972694669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 ROOSEVELT RD STE 101",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832801",
            "telephone_number": "219-462-1619",
            "fax_number": "219-548-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 ROOSEVELT RD STE 101",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832801",
            "telephone_number": "219-462-1619",
            "fax_number": "219-548-0867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8687 Connecticut St",
            "address_2": "Ste F",
            "address_purpose": "LOCATION",
            "city": "Merrillville",
            "state": "IN",
            "postal_code": "464106361",
            "country_code": "US",
            "telephone_number": "219-769-7800",
            "fax_number": "219-755-0748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE-PORTER CARDIOVASCULAR PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "219-477-4452"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "50000940A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100141870A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.