Active NPI
Dennis Leo Anco, CPO, LPO
- Prosthetist
- Woodbury, MN
National Provider Identifier
1013568229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- 1089
- Practice address
- 1854 Evergreen Draw
Woodbury, MN 55125-2306 - Phone
- (763) 228-5697
- NPI assigned
- Sep 28, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | 1089 | MN | |
| Prosthetist | 224P00000X | 1089 | MN | Primary |
Addresses
Primary practice location
1854 Evergreen Draw
Woodbury, MN 55125-2306
Mailing address
1854 Evergreen Draw
Woodbury, MN 55125-2306
Phone (763) 228-5697
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CPO04135 | Other | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS | |
| 1089 | Other | MN | BOARD OF PODIATRIC MEDICINE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1089 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569628800000",
"number": "1013568229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1854 EVERGREEN DRAW",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252306",
"telephone_number": "763-228-5697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1854 EVERGREEN DRAW",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252306",
"telephone_number": "763-228-5697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANCO",
"first_name": "DENNIS",
"middle_name": "LEO",
"name_prefix": "Mr.",
"credential": "CPO, LPO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-28",
"last_updated": "2019-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "MN",
"license": "1089",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "MN",
"license": "1089",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS",
"identifier": "CPO04135",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF PODIATRIC MEDICINE",
"identifier": "1089",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.