MR. ANTONIO MARIO SERGIO SR. (NPI# 1437301074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437301074 |
| Entity Type | Individual |
| Full Name | MR. ANTONIO MARIO SERGIO SR. |
| Credential | REG SHOE-MAKER MERCH |
| Practice Address |
1508 Mishawaka Avenue South Bend IN 46615-1426 |
| Practice Telephone | 5742469700 |
| Mailing Telephone | 5742469700 |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225000000X | Orthotic Fitter | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1508 MISHAWAKA AVENUE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46615-1426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679954804 | Healthlinc, Inc. | Clinic/Center | 1002 S Esther St, South Bend, IN 46615 | 2015-06-12 |
| 1861897688 | Michelle Jean Streb | Registered Nurse | 1960 Northside Boulevard, South Bend, IN 46615 | 2014-10-23 |
| 1275848962 | Charles Mikel Craig | Optometrist | 220 N. Ironwood Dr., South Bend, IN 46615 | 2010-08-18 |
| 1710219613 | Debra Vasquez | Occupational Therapy Assistant | 1950 Ridgedaleroad, South Bend, IN 46615 | 2010-02-03 |
| 1114259132 | Christopher Joseph Smith | Physical Therapist | 1005 Hickory Rd, South Bend, IN 46615 | 2010-02-01 |
| 1295064525 | Starlight Care Facilities, Inc | Skilled Nursing Facility | 915 So. 27th Street, South Bend, IN 46615 | 2009-12-16 |
| 1699002642 | Ann G Pryor | Contractor | 1516 E. Wayne St., South Bend, IN 46615 | 2009-11-12 |
| 1891917449 | Logan Community Resources, Inc. | Community/Behavioral Health | 2505 E. Jefferson Blvd, South Bend, IN 46615 | 2007-05-03 |
| 1487712683 | Julie Gaydos Plagens | Dentist | 604 South Eddy St, South Bend, IN 46615 | 2006-12-04 |
| 1629163084 | Edward F Klodzinski | Counselor | 3603 E. Jefferson Blvd., South Bend, IN 46615 | 2006-10-03 |
| Find all providers in zip 46615 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487176293 | Adam Lee Waugh | Orthotist | 17530 Dugdale Dr, South Bend, IN 46635-1583 | 2017-07-13 |
| 1790209864 | Kelly Ann Roth | Orthotist | 17530 Dugdale Dr, South Bend, IN 46635-1583 | 2017-08-01 |
| 1598289654 | Eric Schopmeyer | Orthotist | 17530 Dugdale Dr, South Bend, IN 46635-1583 | 2017-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720587520 | Cyrus Maude | Orthotist | 1700 E 38th St # 346, Marion, IN 46953-4568 | 2018-02-07 |
| 1285132324 | Seth Cochrill | Orthotist | 3445 W. 96th St., Indianapolis, IN 46268 | 2018-01-23 |
| 1063653053 | Gary N Barnes | Orthotist | 61 Worman St, Indianapolis, IN 46227-5122 | 2009-03-20 |
| 1871513614 | Larry Lee Libbee | Orthotist | 7735 W Jefferson Blvd, Suite C, Fort Wayne, IN 46804-4135 | 2006-07-21 |
| 1841296340 | Riverside Prosthetic, Inc. | Orthotist | 5921 Vogel Rd, Evansville, IN 47715-4020 | 2005-06-21 |
| 1467949545 | Craig Richard Decamp | Orthotist | 2041 Klondike Rd, West Lafayette, IN 47906-5122 | 2018-04-16 |
| 1174020317 | Douglas Bryant Hodge | Orthotist | 9591 Valparaiso Ct, Indianapolis, IN 46268-1130 | 2018-04-12 |
| 1326549296 | Kathryn Spottiswood | Orthotist | 6629 W Lincoln Hwy Ste 1, Crown Point, IN 46307-5170 | 2018-02-26 |
| 1518483338 | Lauren Danielle Brady | Orthotist | 3445 W 96th St, Indianapolis, IN 46268-1102 | 2017-08-15 |
| 1356865364 | Megan Smith | Orthotist | 3445 W 96th St, Indianapolis, IN 46268-1102 | 2017-08-01 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.