NPIMap

Organization Active NPI

Healthdrive Podiatry Group, PC

Doing business as HealthDrive Podiatry Group

  • Podiatrist
  • Princeton, NJ
National Provider Identifier
1013106533
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
HEALTHDRIVE PODIATRY GROUP, PC
Doing business as
HealthDrive Podiatry Group
Practice address
103 Carnegie Ctr
Suite 300
Princeton, NJ 08540-6235
Phone
(888) 964-6681
Fax
(888) 662-0859
NPI assigned
Oct 22, 2007
Last updated
Dec 31, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHDRIVE PODIATRY GROUP, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Authorized official

Name
Dr. Shadi Adib Abboud, DPMNPI 1083704860
Title
Treasuer/Practice Director
Phone
(857) 255-0486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

103 Carnegie Ctr
Suite 300
Princeton, NJ 08540-6235

Mailing address

100 Crossing Blvd
Suite 500
Framingham, MA 01702-5555
Phone (617) 964-6681

Other names 1

  • HealthDrive Podiatry Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050810000144 NJ Part B Supplier - Clinic/Group Practice 3375446958 Receives reassigned benefits from 6 practitioners
Practice locations: Princeton, NJ

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Diadra M Wright DPM10 organizations share this tax ID, including this one
Part of
Diadra M Wright DPM

Other organizations with this tax ID 9

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

Locations

100 Crossing Blvd
Ste 500
Framingham, MA 01702

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Morristown ManorMorristown, IN, CCN 155691 Skilled nursing facility Adp of the SNF Mar 7, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1013106533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROSSING BLVD",
            "address_2": "SUITE 500",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017025555",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 CARNEGIE CTR",
            "address_2": "SUITE 300",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085406235",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHDRIVE PODIATRY GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHDRIVE PODIATRY GROUP, PC",
        "enumeration_date": "2007-10-22",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "ABBOUD",
        "authorized_official_first_name": "SHADI",
        "authorized_official_middle_name": "ADIB",
        "authorized_official_title_or_position": "TREASUER/PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "857-255-0486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthDrive Podiatry Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthDrive Podiatry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, NJ

Sources for this page

Verify at the official NPI Registry.