James Edwin Prommersberger, DPM

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

Sex

Male

Sole proprietor

Yes

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

• Advanced Arthroscopic Foot & Ankle Associates, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Boardman, OH
  • NPI 1659638104

  Foot & Ankle Surgery

  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 2, 2008.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0774194",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000177949",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  TRAVELERS",
            "identifier": "P00199462",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MOUNTAIN STATE",
            "identifier": "000601363",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WV",
            "identifier": "0099572000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Professional Dental Alliance
• Professional Dental Alliance
• Professional Dental Alliance Specialty, LLC
• Progressive Women'S Care, Inc.
• Nicholas G Proia, MD
• Joseph G Protain, DO
• Jennifer Prozy
• Psycare, Inc.
• Quest Diagnostics of Pennsylvania Inc
• Brenda Rach

• All providers in Boardman, OH
• Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.