NPIMap

Organization Active NPI

Paul Potach D.P.M.,P.C.

Doing business as Berwyn Foot & Ankle Center

  • Non-Pharmacy Dispensing Site
  • Berwyn, IL
National Provider Identifier
1003418823
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
PAUL POTACH D.P.M.,P.C.
Doing business as
Berwyn Foot & Ankle Center
Practice address
3100 Oak Park Ave
Berwyn, IL 60402-3291
Phone
(708) 484-3338
Fax
(708) 484-2059
NPI assigned
Nov 16, 2020
Last updated
Nov 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul Potach, D.P.M.
Title
Owner
Phone
(708) 484-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

3100 Oak Park Ave
Berwyn, IL 60402-3291

Mailing address

3100 South Oak Park Ave
Berwyn, IL 60402
Phone (708) 484-3338

Other names 1

  • Berwyn Foot & Ankle Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Paul Potlach DPM4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3100 Oak Park Ave
Berwyn, IL 60402
Phone (708) 484-3338

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/25323118-f910-447e-97a3-efa84a07950e/

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1003418823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SOUTH OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "60402",
            "telephone_number": "708-484-3338",
            "fax_number": "708-484-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023291",
            "telephone_number": "708-484-3338",
            "fax_number": "708-484-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL POTACH D.P.M.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "POTACH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-484-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berwyn Foot & Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.