Organization Active NPI

Santa Monica Podiatry Group, Inc.

  • Primary Podiatric Medicine Podiatrist
  • Santa Monica, CA
National Provider Identifier
1043245525
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
E2764 Issued in CA
Legal business name
SANTA MONICA PODIATRY GROUP, INC.
Practice address
1260 15TH St
Suite 1014
Santa Monica, CA 90404-1135
Phone
(310) 451-1618
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Terry Jay Boykoff, DPM
Title
President
Phone
(310) 451-1618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP1101X E2764 CA Primary

Addresses

Primary practice location

1260 15TH St
Suite 1014
Santa Monica, CA 90404-1135

Mailing address

1260 15TH St
Suite 1014
Santa Monica, CA 90404-1135
Phone (310) 451-1618

Other identifiers 1

IdentifierTypeStateIssuer
048OtherCANEIC SPECIALTY CODE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070716000753 CA Part B Supplier - Clinic/Group Practice 5193825495 Receives reassigned benefits from 3 practitioners
Practice locations: Santa Monica, CA
O20100930099696 CA DME Supplier - Physician - Podiatry 5193825495 Practice locations: Santa Monica, CA

National Provider Directory

National Provider Directory

Locations

1260 15th St
Ste 1014
Santa Monica, CA 90404
Phone (310) 451-1618

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1043245525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 15TH ST",
            "address_2": "SUITE 1014",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041135",
            "telephone_number": "310-451-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 15TH ST",
            "address_2": "SUITE 1014",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041135",
            "telephone_number": "310-451-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MONICA PODIATRY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BOYKOFF",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-451-1618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E2764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIC SPECIALTY CODE",
            "identifier": "048",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.