Individual provider Active NPI

James Edwin Prommersberger, DPM

  • Podiatrist
  • Boardman, OH
National Provider Identifier
1073584686
Registry record updated Jun 2, 2008
On this page

OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • Section 1128a(1) exclusion effective Jan 19, 2022.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36-00-2619 Issued in OH
Practice address
940 Windham CT
Suite #3
Boardman, OH 44512-5060
Phone
(330) 726-3348
Fax
(330) 726-3856
NPI assigned
Jan 31, 2006
Last updated
Jun 2, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 36-00-2619 OH Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 36-00-2619 OH

Addresses

Primary practice location

940 Windham CT
Suite #3
Boardman, OH 44512-5060

Mailing address

940 Windham CT
Suite #3
Boardman, OH 44512-5060
Phone (330) 726-3348

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
240OHMDReflexologist
2619OHMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Arthroscopic Foot & Ankle Associates, Inc. Foot & Ankle Surgery PastSince Jan 1, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1073584686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 WINDHAM CT",
            "address_2": "SUITE #3",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125060",
            "telephone_number": "330-726-3348",
            "fax_number": "330-726-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 WINDHAM CT",
            "address_2": "SUITE #3",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125060",
            "telephone_number": "330-726-3348",
            "fax_number": "330-726-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROMMERSBERGER",
        "first_name": "JAMES",
        "middle_name": "EDWIN",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36-00-2619",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36-00-2619",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.