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GREAT LAKES FOOT & ANKLE CENTERS INC
NPI 1295941409
Podiatrist - Foot & Ankle Surgery in Kenosha, WI

Active since May 15, 2007
6123 GREEN BAY RD, SUITE 100, KENOSHA, WI 53142(262) 652-3668(262) 652-0564 Get Directions Write a Review

NPPES record last updated: September 20, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Great Lakes Foot & Ankle Centers Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES FOOT & ANKLE CENTERS INC (NPI 1295941409) is a healthcare organization registered as a foot & ankle surgery in Kenosha, Wisconsin and active in the NPI registry since May 2007. The organization lists John L Bostanche, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1295941409
Entity TypeOrganization
Primary Taxonomy213ES0103X
Legal Business NameGREAT LAKES FOOT & ANKLE CENTERS INC
Location Address6123 GREEN BAY RD, SUITE 100Kenosha, WI 53142-2927
Mailing Address6123 Green Bay Rd, Suite 100Kenosha, WI 53142-2927 · (262) 652-3668 · Fax (262) 652-0564
Phone(262) 652-3668
Fax(262) 652-0564
Organization SubpartNo
Authorized OfficialJohn L BostanchePhysician/owner · (262) 652-3668
Enumeration DateMay 15, 2007
Last NPPES UpdateSeptember 20, 2021
NPPES CertifiedSeptember 20, 2021
✔ NPI 1295941409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
Licenses✔ Licensed in WI · 025✔ Licensed in IL · 016
6123 GREEN BAY RD, Kenosha, WI 53142
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Other Identifiers 3

Medicaid43215000WI
Medicaid43237400WI
Medicaid43220100WI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Quartz.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Great Lakes Foot & Ankle Centers Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Great Lakes Foot & Ankle Centers Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

John Bostanche, D.P.M.
Podiatry
NPI 1821092420
6123 GREEN BAY RD STE 100
Kenosha, WI 53142
(262) 657-3668
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Foot & Ankle Centers Inc's NPI number?

The NPI number for Great Lakes Foot & Ankle Centers Inc is 1295941409. It was assigned to this organization in the NPPES registry on May 15, 2007.

Where is Great Lakes Foot & Ankle Centers Inc located?

Great Lakes Foot & Ankle Centers Inc is located at 6123 Green Bay Rd Suite 100, Kenosha, WI 53142. The listed phone number is (262) 652-3668.

What is Great Lakes Foot & Ankle Centers Inc's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Great Lakes Foot & Ankle Centers Inc enrolled in Medicare?

Yes. Great Lakes Foot & Ankle Centers Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Great Lakes Foot & Ankle Centers Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Podiatry) reassigns their Medicare billing to Great Lakes Foot & Ankle Centers Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Great Lakes Foot & Ankle Centers Inc accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare) and Quartz list Great Lakes Foot & Ankle Centers Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Great Lakes Foot & Ankle Centers Inc was last updated on September 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.