NPIMap

Organization Active NPI

Professional Foot and Ankle Centers, PC

  • Foot & Ankle Surgery Podiatrist
  • Davison, MI
National Provider Identifier
1104025220
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
MW001983 Issued in MI
Legal business name
PROFESSIONAL FOOT AND ANKLE CENTERS, PC
Practice address
605 S State Rd
Davison, MI 48423-1515
Phone
(810) 653-9060
Fax
(810) 658-2248
NPI assigned
Jul 18, 2007
Last updated
Jun 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

Name
Mark R Williams, DPMNPI 1669575478
Title
Provider
Phone
(810) 653-9060

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
Foot & Ankle Surgery Podiatrist 213ES0103X MW001983 MI Primary

Addresses

Primary practice location

605 S State Rd
Davison, MI 48423-1515

Mailing address

PO Box 480
Davison, MI 48423-0480
Phone (810) 653-9060

Other identifiers 1

IdentifierTypeStateIssuer
4632598MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040515000273 MI Part B Supplier - Clinic/Group Practice 6608866223 Receives reassigned benefits from 5 practitioners
Practice locations: Davison, MI; Lapeer, MI
O20100930030777 MI DME Supplier - Physician - Podiatry 6608866223 Practice locations: Davison, MI

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
Tax ID family
Professional Foot and Ankle Centers PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

605 S State Rd
Davison, MI 48423
Phone (810) 653-9060

Practitioners & affiliated clinicians

Practitioners 6

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": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1104025220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 480",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484230480",
            "telephone_number": "810-653-9060",
            "fax_number": "810-658-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S STATE RD",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231515",
            "telephone_number": "810-653-9060",
            "fax_number": "810-658-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL FOOT AND ANKLE CENTERS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "810-653-9060",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MI",
            "license": "MW001983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4632598",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davison, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.