GREAT LAKES PEDIATRIC SURGEONS, INC.
NPI 1669455267
Surgery - Pediatric Surgery in Fort Wayne, IN
About Great Lakes Pediatric Surgeons, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GREAT LAKES PEDIATRIC SURGEONS, INC. (NPI 1669455267) is a healthcare organization registered as a pediatric surgery in Fort Wayne, Indiana and active in the NPI registry since November 2005. The organization lists David A. Smith, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Great Lakes Pediatric Surgeons, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Great Lakes Pediatric Surgeons, Inc., which bills Medicare for the services they deliver. Of these, 5 practice at this address. They are listed nearest first.
Clinicians, nearest first (6)
Fort Wayne, IN 46804
Fort Wayne, IN 46804
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 Pediatric Surgeons, Inc.'s NPI number?
The NPI number for Great Lakes Pediatric Surgeons, Inc. is 1669455267. It was assigned to this organization in the NPPES registry on November 29, 2005.
Where is Great Lakes Pediatric Surgeons, Inc. located?
Great Lakes Pediatric Surgeons, Inc. is located at 7613 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804. The listed phone number is (260) 469-7337.
What is Great Lakes Pediatric Surgeons, Inc.'s specialty?
The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.
Is Great Lakes Pediatric Surgeons, Inc. enrolled in Medicare?
Yes. Great Lakes Pediatric Surgeons, Inc. is registered in the Medicare PECOS enrollment system.
When is Great Lakes Pediatric Surgeons, Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Indiana, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Great Lakes Pediatric Surgeons, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Great Lakes Pediatric Surgeons, 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. The largest specialties are General Surgery (3) and Nurse Practitioner (3). Of these, 5 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Great Lakes Pediatric Surgeons, Inc. accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Anthem Blue Cross and Blue Shield list Great Lakes Pediatric Surgeons, 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 Pediatric Surgeons, Inc. was last updated on March 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.
# Great Lakes Pediatric Surgeons, Inc. · NPI 1669455267
Pediatric Surgery organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since November 29, 2005.
## Identity
- **NPI:** 1669455267 (Entity type: Organization)
- **Enumerated:** November 29, 2005
- **Primary specialty:** Surgery - Pediatric Surgery · taxonomy 2086S0120X
- **Organization subpart:** No
- **Authorized official:** David Smith, PRESIDENT
## Practice location
- **Address:** 7613 W JEFFERSON BLVD STE 200, Fort Wayne, IN 46804-4182
- **Phone:** (260) 469-7337 · **Fax:** (260) 469-7340
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Indiana, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 6 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: General Surgery (3), Nurse Practitioner (3); 5 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 14, 2008
- **Other identifiers:** Medicare PIN 220530A (IN)
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Source: [NPI Profile](https://npiprofile.com/npi/1669455267) · Data from the CMS NPPES public registry.