Excelsior Podiatry Clinic PLLC
Organization Active NPI Foot & Ankle Surgery Podiatrist · Somerville, TN
NPI 1003085515 · NPPES record last updated Apr 13, 2010
Key facts
- NPI
- 1003085515
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- DPM0000000649 (TN)
- Legal business name
- EXCELSIOR PODIATRY CLINIC PLLC
- Practice address
- 214 Lakeview Rd
Somerville, TN 38068-9737 - Phone
- (901) 516-4005
- Fax
- (901) 516-4023
- NPI assigned
- Feb 28, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. John Bell, DPM
- Title
- Doctor
- Phone
- (901) 516-4005
Practitioners 1
-
John Elijah Bell, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080519000768 | TN | Part B Supplier - Clinic/Group Practice | 3274602115 |
Receives reassigned benefits from 1 practitioner Practice locations: Somerville, TN |
National Provider Directory
Locations
3960 New Covington Pike
#290
Memphis, TN 38128
214 Lakeview Rd
Ste 183
Somerville, TN 38068
Phone (901) 516-4005
Interoperability endpoints
- https://api.platform.athenahealth.com/8131/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | DPM0000000649 | TN | Yes |
Addresses
Primary practice location
214 Lakeview Rd
Somerville, TN 38068-9737
Mailing address
PO Box 460
Oakland, TN 38060-0460
Phone (901) 516-4005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33542121 | Medicaid | TN |
Other providers in Somerville, TN
- Shanice Douglas
- Dwayne F Richardson DDS Estate
- Elite Pediatric and Adolescent Medicine
- Michelle G Elrod
- Encore Health and Wellness PLLC
- Excelsior Podiatry Clinic PLLC
- Family First Primary Care, Inc
- Meredith Fawcett
- Fayette County Schools
- Lloyann Ferrell-Bishop
All providers in Somerville, TN · Foot & Ankle Surgery Podiatrist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.