Pediatric Orthotic and Prosthetic Services - Northeast, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHEAST, LLC

Practice address

1645 W 8TH St
Erie, PA 16505-5007

Phone

(814) 875-8700

Fax

(814) 875-8756

NPI assigned

Sep 28, 2015

Organization subpart

Yes

Parent organization

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHEAST, LLCAs reported in NPPES

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

Authorized official

Name

Alex Betancourt

Title

Manager

Phone

(814) 875-8895

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Pediatric Orthotic and Prosthetic Services- Northeast, LLC

  • Prosthetic/Orthotic Supplier
  • Philadelphia, PA
  • NPI 1336537042

  1951617950

  Same PAC ID
• Pediatric Orthotic and Prosthetic Services-Northeast,LLC

  • Prosthetic/Orthotic Supplier
  • Springfield, MA
  • NPI 1902208945

  1951617950

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Pediatric Orthotic and Prosthetic Services - Northeast LLC3 organizations share this tax ID, including this one

Part of

Pediatric Orthotic and Prosthetic Services - Northeast LLC

Other organizations with this tax ID 2

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

• Pediatric Orthotic and Prosthetic Services- Northeast, LLC

  • Prosthetic/Orthotic Supplier
  • Philadelphia, PA
  • NPI 1336537042
  NPD tax ID
• Pediatric Orthotic and Prosthetic Services-Northeast,LLC

  • Prosthetic/Orthotic Supplier
  • Springfield, MA
  • NPI 1902208945
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shriners Hospitals for Children

  • Children's Hospital
  • Honolulu, HI
  • NPI 1316065360

  Member Of

  NPD member

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1992175459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947109",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947109",
            "telephone_number": "813-367-2876",
            "fax_number": "813-518-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165055007",
            "telephone_number": "814-875-8700",
            "fax_number": "814-875-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHEAST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - NORTHEAST, LLC",
        "enumeration_date": "2015-09-28",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "BETANCOURT",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "814-875-8895"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Cardiology of Erie
• Pediatric Care Center of Erie, PC
• Pediatric Dentistry of Erie LLC
• Pediatric Dermatology Associates of Erie LLC
• Pediatric Ophthalmology of Erie, Inc
• Roshell L Peeso, PHARMD
• Alison Marie Mallory Pehl, DO
• Madeline Grace Pelc, MS, NCC, LPC, CCTP
• Tricia Lee Pelc, LPC, NCC
• Timothy D Pelkowski, M.D.

• Prosthetic/Orthotic Supplier in Erie, PA
• Providers in Erie, PA by specialty
• Prosthetic/Orthotic Supplier in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.