Organization Active NPI

Podcare

  • Podiatrist
  • Saint Clair Shores, MI
National Provider Identifier
1114239886
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SR400227 Issued in MI
Legal business name
PODCARE
Practice address
21327 Harper Ave
Suite C
Saint Clair Shores, MI 48080-2200
Phone
(989) 791-2455
Fax
(989) 791-2455
NPI assigned
Jul 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

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

Authorized official

Name
Steven Repitor, DPM
Title
Ceo
Phone
(989) 791-2455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X SR400227 MI Primary

Addresses

Primary practice location

21327 Harper Ave
Suite C
Saint Clair Shores, MI 48080-2200

Mailing address

3061 Christy Way
Saginaw, MI 48603-2267
Phone (989) 791-2455

Other identifiers 1

IdentifierTypeStateIssuer
1194760835MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Podcare2 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.

NPI Registry JSON

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1114239886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 CHRISTY WAY",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032267",
            "telephone_number": "989-791-2455",
            "fax_number": "989-791-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21327 HARPER AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802200",
            "telephone_number": "989-791-2455",
            "fax_number": "989-791-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "REPITOR",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-791-2455",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "SR400227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194760835",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; 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.