GREAT LAKES ORTHOPEDICS & SPORTS MEDICINE, PC (NPI# 1669472270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669472270 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ORTHOPEDICS & SPORTS MEDICINE, PC |
| Practice Address |
9615 Keilman St Saint John IN 46373-9406 |
| Practice Telephone | 2193650220 |
| Practice Fax Number | 2193650226 |
| Mailing Telephone | 2193650220 |
| Mailing Fax Number | 2193650226 |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | KEITH R. PITCHFORD (PRESIDENT/CEO) |
| Authorized Official Telephone | 2193650220 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
07001187A | IN | Podiatric Medicine & Surgery Service Providers |
| Y | 207X00000X | Orthopaedic Surgery | 02002102 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BC/BS IL | 90001186 | 01 |
| IN | RAILROAD MEDICARE | DC2442 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1020 E Commercial Ave, Lowell, IN 463562310 | 2196966353 | 2196966368 |
| Street Address |
9615 KEILMAN ST |
| City | SAINT JOHN |
| State | IN |
| Zip Code | 46373-9406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639648322 | Mariah Nicole Isaacs | Physician Assistant | 9615 Keilman St, Saint John, IN 46373-9406 | 2018-11-26 |
| 1548764376 | Great Lakes Orthopedics Physical Therapy P.C. | Physical Therapist | 9615 Keilman St, Saint John, IN 46373-9406 | 2018-03-19 |
| 1558613547 | Timothy Brian Williams | Physician Assistant | 9615 Keilman St, Saint John, IN 46373-9406 | 2012-10-15 |
| 1851682561 | Natasha Mandula | Podiatrist | 9615 Keilman St, Saint John, IN 46373-9406 | 2011-04-28 |
| 1659699890 | Rehabilitation & Musculoskeletal Medicine Specialist, LLC | Physical Medicine & Rehabilitation | 9615 Keilman St, Saint John, IN 46373-9406 | 2010-05-12 |
| 1346424728 | Center for Orthotic & Prosthetic Excellence, LLC | Prosthetic/Orthotic Supplier | 9615 Keilman St, Suite 200, Saint John, IN 46373 | 2007-12-20 |
| 1972521771 | Linda Kristina | Physical Therapist | 9615 Keilman St, Saint John, IN 46373-9406 | 2006-07-18 |
| 1821039389 | Richard E Mcclain | Orthopaedic Surgery | 9615 Keilman St, Saint John, IN 46373-9406 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023641123 | Lisa A Arteaga | Occupational Therapy Assistant | 10700 Park Place of St John, St John, IN 46373 | 2020-02-17 |
| 1306493507 | Athletico Ltd | Physical Therapist | 10081 Wicker Ave #4, Saint John, IN 46373 | 2019-08-22 |
| 1083014971 | Courtney Olavarria | Registered Nurse | 8915 West 93rd Avenue, Clark Middle School, Saint John, IN 46373 | 2014-08-27 |
| 1316368111 | Tracy Lynn Wargo | Registered Nurse | 8801 Wicker Ave., Kolling Elementary, St. John, IN 46373 | 2013-12-20 |
| 1245587989 | Joshua Dejong | Physical Therapist | 10200 Wicker Ave Ste 1, Saint John, IN 46373 | 2012-08-13 |
| 1053406629 | Corlin Alden Stein | Chiropractor | 9161 Wicker Avenue (us 41), St. John, IN 46373 | 2006-10-03 |
| 1235190216 | Tarak R Chokshi | Internal Medicine | 10200 Wicker Avenue, St John, IN 46373 | 2006-03-30 |
| 1154397057 | Norbert A Matulis | Dentist | 9207 Wicker Avenue, St John, IN 46373 | 2006-02-28 |
| 1568462729 | Keith R. Pitchford | Orthopaedic Surgery | 9615 Keilman Street, Saint John, IN 46373 | 2005-07-28 |
| 1528483021 | Creating Smiles PC | Dentist | 8217 Wicker Ave, St John, IN 46373 | 2014-02-20 |
| Find all providers in zip 46373 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568462729 | Keith R. Pitchford | Orthopaedic Surgery | 9615 Keilman Street, Saint John, IN 46373 | 2005-07-28 |
| 1821039389 | Richard E Mcclain | Orthopaedic Surgery | 9615 Keilman St, Saint John, IN 46373-9406 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164038618 | Union Associated Physicians Clinic, LLC | Orthopaedic Surgery | 801 S Main St Ste 200, Clinton, IN 47842-2261 | 2020-09-21 |
| 1699317529 | Lakeshore Bone & Joint Institute, PC | Orthopaedic Surgery | 759 45th St Ste 201, Munster, IN 46321-2938 | 2019-10-11 |
| 1609417260 | Orthopaedics-indianapolis, Inc | Orthopaedic Surgery | 1579 Olive Branch Parke Lane, Suite 130, Greenwood, IN 46143 | 2019-10-04 |
| 1104330034 | Hinsdale Orthopaedic Associates, S.c. | Orthopaedic Surgery | 8141 S Calumet Ave, Unit 1, Munster, IN 46321 | 2017-11-30 |
| 1679022925 | Stephen Stein | Orthopaedic Surgery | 13198 N County Road 400 E, Batesville, IN 47006-8881 | 2016-09-28 |
| 1013371277 | Orthopaedics-indianapolis, Inc | Orthopaedic Surgery | 17471 Wheeler Road, Suite 112, Westfield, IN 46074-6901 | 2016-04-13 |
| 1194184671 | Greenwood Orthopedics PC | Orthopaedic Surgery | 965 Emerson Parkway, Suite K, Greenwood, IN 46143-6274 | 2016-02-12 |
| 1467826032 | Franciscan Physician Network | Orthopaedic Surgery | 759 45th Street, Suite 201, Munster, IN 46321 | 2015-11-19 |
| 1285019851 | Community Physicians of Indiana Inc | Orthopaedic Surgery | 2312 S Dixon Road, Suite 200, Kokomo, IN 46902-6423 | 2015-07-24 |
| 1730561291 | Cody Shafer | Orthopaedic Surgery | 1120 W Michigan St Rm 600, Indianapolis, IN 46202-5209 | 2015-06-22 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOHN |
| Zip Code | 46373 |
Please comment or provide details below to improve the information on GREAT LAKES ORTHOPEDICS & SPORTS MEDICINE, PC.
| 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.