NPIMap

Organization Active NPI

Central Florida Foot and Ankle

  • Foot & Ankle Surgery Podiatrist
  • Winter Haven, FL
National Provider Identifier
1093809097
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO2760 Issued in FL
Legal business name
CENTRAL FLORIDA FOOT AND ANKLE
Practice address
101 6TH St NW
Winter Haven, FL 33881-4630
Phone
(863) 299-4551
Fax
(863) 299-2310
NPI assigned
Oct 3, 2006
Last updated
Mar 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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

Authorized official

Name
Dr. Tatiana A Wellens-Bruschayt, D.P.M, PHD
Title
President
Phone
(863) 299-4551

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X PO2760 FL Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X PO2804 FL
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X PO3070 FL

Addresses

Primary practice location

101 6TH St NW
Winter Haven, FL 33881-4630

Mailing address

PO Box 7472
Winter Haven, FL 33883-7472
Phone (863) 299-4551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041011000208 FL Part B Supplier - Clinic/Group Practice 1254390610 Receives reassigned benefits from 2 practitioners
Practice locations: Davenport, FL; Lakeland, FL; Winter Haven, FL
O20100930082764 FL DME Supplier - Physician - Podiatry 1254390610 Practice locations: Winter Haven, FL

National Provider Directory

National Provider Directory

Locations

1115 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 299-4551

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1093809097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7472",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338837472",
            "telephone_number": "863-299-4551",
            "fax_number": "863-299-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 6TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814630",
            "telephone_number": "863-299-4551",
            "fax_number": "863-299-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA FOOT AND ANKLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "WELLENS-BRUSCHAYT",
        "authorized_official_first_name": "TATIANA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-299-4551",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M, PHD"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO2760",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO2804",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.