NPIMap

Organization Active NPI

Issaquah Foot & Ankle Specialists, P.L.L.C.

  • Podiatrist
  • Issaquah, WA
National Provider Identifier
1073886479
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
601627348 Issued in WA
Legal business name
ISSAQUAH FOOT & ANKLE SPECIALISTS, P.L.L.C.
Practice address
450 NW Gilman Blvd
Suite 303
Issaquah, WA 98027-2483
Phone
(425) 391-8666
Fax
(425) 392-6433
NPI assigned
Feb 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Authorized official

Name
Dr. Timothy Young, DPMNPI 1508855966
Title
Owner
Phone
(425) 391-8666

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 601627348 WA Primary

Addresses

Primary practice location

450 NW Gilman Blvd
Suite 303
Issaquah, WA 98027-2483

Mailing address

450 NW Gilman Blvd
Suite 303
Issaquah, WA 98027-2483
Phone (425) 391-8666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120510000440 WA Part B Supplier - Clinic/Group Practice 7618139577 Receives reassigned benefits from 3 practitioners
Practice locations: Issaquah, WA
O20130304000243 WA DME Supplier - Physician - Podiatry 7618139577 Practice locations: Issaquah, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

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": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1073886479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 NW GILMAN BLVD",
            "address_2": "SUITE 303",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272483",
            "telephone_number": "425-391-8666",
            "fax_number": "425-392-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NW GILMAN BLVD",
            "address_2": "SUITE 303",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272483",
            "telephone_number": "425-391-8666",
            "fax_number": "425-392-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSAQUAH FOOT & ANKLE SPECIALISTS, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-391-8666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "601627348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; 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.