Active NPI
Charles W Mistretta, DPM
- Foot Surgery Podiatrist
- Jamestown, NY
National Provider Identifier
1083624209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- N4011
- Practice address
- 23 Ivy St
Jamestown, NY 14701-8212 - Phone
- (716) 664-9698
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | N4011 | NY | Primary |
Addresses
Primary practice location
23 Ivy St
Jamestown, NY 14701-8212
Mailing address
23 Ivy St
Jamestown, NY 14701-8212
Phone (716) 664-9698
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00957731 | Medicaid | NY | |
| AA1409 | Other | NY | MEDICARE-PTAN |
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
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N4011 | NY | MD | Foot Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chautauqua County Chapter of Nysarc Inc | Past | Accepting new patients | |
| Pine Valley Central School | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba The Resource Center
- Long Term Care Pharmacy
- Jamestown, NY
- NPI 1427095892
-
- Local Education Agency (LEA)
- South Dayton, NY
- NPI 1750421475
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1083624209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 IVY ST",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147018212",
"telephone_number": "716-664-9698",
"fax_number": "716-661-3851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 IVY ST",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147018212",
"telephone_number": "716-664-9698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISTRETTA",
"first_name": "CHARLES",
"middle_name": "W",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "NY",
"license": "N4011",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00957731",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE-PTAN",
"identifier": "AA1409",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.