NPIMap

Organization Active NPI

PNC Podiatry of Arizona PC

  • Foot & Ankle Surgery Podiatrist
  • Mesa, AZ
National Provider Identifier
1063168359
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PNC PODIATRY OF ARIZONA PC
Practice address
1520 S Dobson Rd Ste 312
Mesa, AZ 85202-4700
Phone
(480) 844-8218
Fax
(480) 844-8218
NPI assigned
Feb 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Alexander ReyzelmanNPI 1023192721
Title
Cmo
Phone
(415) 292-0638

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Sports Medicine PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0000X
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary
Foot Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0131X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X

Addresses

Primary practice location

1520 S Dobson Rd Ste 312
Mesa, AZ 85202-4700

Mailing address

PO Box 32183
Belfast, ME 04915-0199
Phone (415) 645-4525

Other names 1

  • DESERT FOOT & ANKLE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250605001882 AZ Part B Supplier - Clinic/Group Practice 5496264863 Receives reassigned benefits from 7 practitioners
Practice locations: Fountain Hills, AZ; Glendale, AZ; Mesa, AZ

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
PNC Podiatry of Arizona PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

222 Berkeley St
Fl 18
Boston, MA 02116

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26083/brand/1/csg/1/fhir/r4

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

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": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1063168359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32183",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049150199",
            "telephone_number": "415-645-4525",
            "fax_number": "510-399-1364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 S DOBSON RD STE 312",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024700",
            "telephone_number": "480-844-8218",
            "fax_number": "480-844-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNC PODIATRY OF ARIZONA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "REYZELMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "415-292-0638"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DESERT FOOT & ANKLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.