NPIMap

Organization Active NPI

Eddie Davis, DPM, PLLC

  • Podiatrist
  • San Antonio, TX
National Provider Identifier
1114179884
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
EDDIE DAVIS, DPM, PLLC
Practice address
109 Gallery Cir Ste 119
San Antonio, TX 78258-3328
Phone
(210) 490-3668
Fax
(210) 267-5262
NPI assigned
Oct 14, 2008
Last updated
Feb 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Authorized official

Name
Eddie DavisNPI 1609075902
Title
Physician
Phone
(210) 490-3668

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

109 Gallery Cir Ste 119
San Antonio, TX 78258-3328

Mailing address

109 Gallery Cir Ste 119
San Antonio, TX 78258-3328
Phone (210) 490-3668

Other identifiers 1

IdentifierTypeStateIssuer
2094732 GROUPMedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eddie.davis@9929.chartlogic.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090113000603 TX Part B Supplier - Clinic/Group Practice 5991868291 Receives reassigned benefits from 9 practitioners
Practice locations: Boerne, TX; Houston, TX; Katy, TX; New Braunfels, TX; San Antonio, TX
O20130226000439 TX DME Supplier - Physician - Podiatry 5991868291 Practice locations: San Antonio, TX

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

Locations

109 Gallery Cir
Ste 119
San Antonio, TX 78258
Phone (210) 490-3668

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10915/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1114179884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 GALLERY CIR STE 119",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583328",
            "telephone_number": "210-490-3668",
            "fax_number": "210-267-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 GALLERY CIR STE 119",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583328",
            "telephone_number": "210-490-3668",
            "fax_number": "210-267-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDDIE DAVIS, DPM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "210-490-3668"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2094732 GROUP",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eddie.davis@9929.chartlogic.direct-ci.com",
            "affiliation": "N",
            "address_1": "109 Gallery Cir Ste 119",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782583328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.