John T. Carroll, DPM PC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

Legal business name

JOHN T. CARROLL, DPM PC

Practice address

455 Boston Post Rd, Unit #8
Old Saybrook, CT 06475-1554

Phone

(860) 510-0502

Fax

(860) 510-0551

NPI assigned

Dec 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John T Carroll, DPMNPI 1508946054

Title

President

Phone

(860) 510-0502

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John T Carroll, DPM

  • Foot Surgery Podiatrist
  • Old Saybrook, CT
  • NPI 1508946054
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454025600000",
    "number": "1114100989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 BOSTON POST RD, UNIT #8",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751554",
            "telephone_number": "860-510-0502",
            "fax_number": "860-510-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 BOSTON POST RD, UNIT #8",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751554",
            "telephone_number": "860-510-0502",
            "fax_number": "860-510-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T. CARROLL, DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2016-01-29",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-510-0502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME/MEDICAL SUPPLY DEALER",
            "identifier": "008063266",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008059379",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Julia S Tucker Wood
• Ann Kabza, FNP-C

• Foot Surgery Podiatrist in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• Foot Surgery Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; 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.