| Edgewater Systems For Balanced Living, Inc. | |
|
1100 W 6th Ave Gary IN 46402-1711 | |
| (219) 885-4264 | |
| (219) 882-0242 |
| Full Name | Edgewater Systems For Balanced Living, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 W 6th Ave, Gary, Indiana |
| Authorized Official Name and Position | Lunette Lashaun Lott (DIRECTOR ACCTS. RECEIVABLES) |
| Authorized Official Contact | 2198854264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Systems For Balanced Living, Inc. 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 | Edgewater Systems For Balanced Living, Inc. 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 |
| NPI Number | 1588705784 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 01/11/2019 |
| Medicare PECOS PAC ID | 9234398397 |
|---|---|
| Medicare Enrollment ID | O20120308000405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588705784 | NPI | - | NPPES |
| 100273230 | Medicaid | IN | |
| 200079390 | Medicaid | IN |
| Provider Name | Pratima M Mehta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780693341 PECOS PAC ID: 8325935364 Enrollment ID: I20040303000643 |
| Provider Name | Robert White |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093723496 PECOS PAC ID: 3173572583 Enrollment ID: I20050112000841 |
| Provider Name | Roland Hayes Walker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891875647 PECOS PAC ID: 2062454820 Enrollment ID: I20050523001047 |
| Provider Name | Charles F Motley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316948789 PECOS PAC ID: 2365491982 Enrollment ID: I20050823000339 |
| Provider Name | Surendra Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528088689 PECOS PAC ID: 5890884928 Enrollment ID: I20071127000765 |
| Provider Name | Dewnzar D Howard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912016759 PECOS PAC ID: 1153401088 Enrollment ID: I20080104000478 |
| Provider Name | Kupusamy Umapathy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306842786 PECOS PAC ID: 1557386356 Enrollment ID: I20080729000743 |
| Provider Name | Michelle Breunig |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1881724730 PECOS PAC ID: 0143394718 Enrollment ID: I20080730000427 |
| Provider Name | Pamela V Tran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447386131 PECOS PAC ID: 1951475227 Enrollment ID: I20080805000149 |
| Provider Name | Diane E Spoljoric |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134213028 PECOS PAC ID: 4880762624 Enrollment ID: I20081007000646 |
| Provider Name | Gerri C Browning |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699782318 PECOS PAC ID: 4981590031 Enrollment ID: I20090807000444 |
| Provider Name | Deborah L Mccullough |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942216478 PECOS PAC ID: 1052453701 Enrollment ID: I20100119000678 |
| Provider Name | Tonia S Amaloo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598996589 PECOS PAC ID: 9335278928 Enrollment ID: I20100519000708 |
| Provider Name | Chiedu J Nchekwube |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790871341 PECOS PAC ID: 5294717609 Enrollment ID: I20111221000552 |
| Provider Name | Mathew V Castelino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912970229 PECOS PAC ID: 8527051572 Enrollment ID: I20120224000000 |
| Provider Name | Mohammad R Butt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881722833 PECOS PAC ID: 8820081870 Enrollment ID: I20120807000699 |
| Provider Name | Sandra Renee Gates Manna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124396072 PECOS PAC ID: 0749431203 Enrollment ID: I20121108000643 |
| Provider Name | Jennifer Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063781532 PECOS PAC ID: 7315192705 Enrollment ID: I20130311000352 |
| Provider Name | Chantal L Walker |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508979725 PECOS PAC ID: 4284865494 Enrollment ID: I20140331002059 |
| Provider Name | Tanya Marie Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245506369 PECOS PAC ID: 4880635614 Enrollment ID: I20151104000477 |
| Provider Name | Stephanie O Bandy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306224597 PECOS PAC ID: 0941511380 Enrollment ID: I20151124000620 |
| Provider Name | Douge Barthelemy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942313366 PECOS PAC ID: 7618910159 Enrollment ID: I20160127001804 |
| Provider Name | Marshall James |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134179963 PECOS PAC ID: 6305858747 Enrollment ID: I20170307001919 |
| Provider Name | Emma Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437499621 PECOS PAC ID: 8820039191 Enrollment ID: I20170614000898 |
| Provider Name | Melinda Jones-saah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477078798 PECOS PAC ID: 2062778061 Enrollment ID: I20171108000053 |
| Provider Name | Edith A Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982142527 PECOS PAC ID: 2365702784 Enrollment ID: I20180205000052 |
| Provider Name | Bianca Chatman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831653690 PECOS PAC ID: 3274873781 Enrollment ID: I20190320001500 |
| Provider Name | Doris Fandohan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679038186 PECOS PAC ID: 1557603974 Enrollment ID: I20190503000868 |
| Provider Name | Lakeysha Patrice Freeny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336761576 PECOS PAC ID: 1658793096 Enrollment ID: I20200612000561 |
| Provider Name | April Donald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083228399 PECOS PAC ID: 5991116253 Enrollment ID: I20201118001611 |
| Provider Name | Laresse Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013516939 PECOS PAC ID: 0648682583 Enrollment ID: I20201217000151 |
| Provider Name | Sharon James |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1659385128 PECOS PAC ID: 6002873510 Enrollment ID: I20230420000482 |
| Provider Name | Chavonn L Dedeaux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255717096 PECOS PAC ID: 8921533472 Enrollment ID: I20241121001211 |
| Provider Name | Monira E Ali |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700344223 PECOS PAC ID: 6507380078 Enrollment ID: I20250404003150 |
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