NPIMap

Organization Active NPI

Alta Ridge Foot Specialists, PLLC

  • Podiatrist
  • Boone, NC
National Provider Identifier
1124414545
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
ALTA RIDGE FOOT SPECIALISTS, PLLC
Practice address
2211 Highway 105
Boone, NC 28607-7813
Phone
(828) 286-1948
Fax
(828) 286-1951
NPI assigned
Apr 13, 2015
Last updated
Jan 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

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

Authorized official

Name
Robert L Van Brederode, DPMNPI 1871590554
Title
Owner/Provider
Phone
(828) 766-7667

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
Podiatrist 213E00000X Primary
Foot & Ankle Surgery Podiatrist 213ES0103X
Foot Surgery Podiatrist 213ES0131X

Addresses

Primary practice location

2211 Highway 105
Boone, NC 28607-7813

Mailing address

440 Altapass Hwy
Spruce Pine, NC 28777-3011
Phone (828) 766-7667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200124000264 NC DME Supplier - Physician - General Practice 2163571258 Practice locations: Boone, NC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Alta Ridge Foot Specialists2 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1124414545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 ALTAPASS HWY",
            "city": "SPRUCE PINE",
            "state": "NC",
            "postal_code": "287773011",
            "telephone_number": "828-766-7667",
            "fax_number": "828-766-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 HIGHWAY 105",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286077813",
            "telephone_number": "828-286-1948",
            "fax_number": "828-286-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA RIDGE FOOT SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "VAN BREDERODE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "828-766-7667",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boone, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; 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.