NPIMap

Organization Active NPI

Advanced Foot & Ankle Care, LTD

  • Podiatric Clinic/Center
  • Springfield, IL
National Provider Identifier
1104899871
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
License
016-004880 Issued in IL
Legal business name
ADVANCED FOOT & ANKLE CARE, LTD
Practice address
1522 S 5TH St
Springfield, IL 62703-2549
Phone
(217) 522-3622
Fax
(217) 522-3046
NPI assigned
Feb 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

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

Authorized official

Name
Dr. Marla Kay Wilson, DPM
Title
President
Phone
(217) 522-3622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X 016-004880 IL Primary

Addresses

Primary practice location

1522 S 5TH St
Springfield, IL 62703-2549

Mailing address

1522 S 5TH St
Springfield, IL 62703-2549
Phone (217) 522-3622

Other identifiers 1

IdentifierTypeStateIssuer
4482080001OtherILDMEPOS

National Provider Directory

National Provider Directory

Locations

120 W Ryder St
Litchfield, IL 62056
Phone (217) 324-2521

111 W Kirkham St
Litchfield, IL 62056
Phone (217) 324-2541

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14585/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301011200000",
    "number": "1104899871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 S 5TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032549",
            "telephone_number": "217-522-3622",
            "fax_number": "217-522-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 S 5TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032549",
            "telephone_number": "217-522-3622",
            "fax_number": "217-522-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT & ANKLE CARE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2011-03-25",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARLA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-522-3622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IL",
            "license": "016-004880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS",
            "identifier": "4482080001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.

Verify at the official NPI Registry.