NPIMap

Organization Active NPI

Los Gatos Podiatry Group, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Los Gatos, CA
National Provider Identifier
1124380688
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E4916 Issued in CA
Legal business name
LOS GATOS PODIATRY GROUP, INC.
Practice address
14651 S Bascom Ave
Suite 215
Los Gatos, CA 95032-2014
Phone
(408) 358-2250
Fax
(408) 358-2258
NPI assigned
Jun 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Authorized official

Name
Dr. Azar Dastgah, DPMNPI 1922302397
Title
President
Phone
(408) 358-2250

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X E4916 CA Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X E4988 CA

Addresses

Primary practice location

14651 S Bascom Ave
Suite 215
Los Gatos, CA 95032-2014

Mailing address

14651 S Bascom Ave
Suite 215
Los Gatos, CA 95032-2014
Phone (408) 358-2250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121011000149 CA Part B Supplier - Clinic/Group Practice 7517116353 Receives reassigned benefits from 4 practitioners
Practice locations: Los Gatos, CA
O20130221000281 CA DME Supplier - Physician - Podiatry 7517116353 Practice locations: Los Gatos, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361923200000",
    "number": "1124380688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14651 S BASCOM AVE",
            "address_2": "SUITE 215",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322014",
            "telephone_number": "408-358-2250",
            "fax_number": "408-358-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14651 S BASCOM AVE",
            "address_2": "SUITE 215",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322014",
            "telephone_number": "408-358-2250",
            "fax_number": "408-358-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS GATOS PODIATRY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2013-02-27",
        "status": "A",
        "authorized_official_last_name": "DASTGAH",
        "authorized_official_first_name": "AZAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "408-358-2250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4916",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4988",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.