Brutico Foot and Ankle Surgery, LLC
Organization Active NPI Foot & Ankle Surgery Podiatrist · Clarks Summit, PA
NPI 1154057362 · NPPES record last updated May 14, 2024
Key facts
- NPI
- 1154057362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- BRUTICO FOOT AND ANKLE SURGERY, LLC
- Practice address
- 255 East Grove Street
Clarks Summit, PA 18411 - Phone
- (570) 936-2960
- Fax
- (570) 936-2961
- NPI assigned
- Jul 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Tara Balsley
- Title
- Practice Administrator
- Phone
- (215) 259-5080
Practitioners 2
-
Sokieu Mach Brutico, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220919001100 | PA | Part B Supplier - Clinic/Group Practice | 2961887567 |
Receives reassigned benefits from 2 practitioners Practice locations: Clarks Green,, PA |
National Provider Directory
Locations
30 Lincoln Ave
Ste 101
Carbondale, PA 18407
255 E Grove St
Clarks Green, PA 18411
Phone (570) 209-7878
409 N Main Ave
Scranton, PA 18504
Phone (570) 342-8731
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | Yes |
Addresses
Primary practice location
255 East Grove Street
Clarks Summit, PA 18411
Mailing address
255 East Grove Street
Clarks Summit, PA 18411
Phone (570) 936-2960
Other practice location 1
409 N Main Ave
Scranton, PA 18504-1798
Phone (570) 936-2960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103894240 | Medicaid | PA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sbrutico@bltmedicalbilling.com | Direct |
Other providers in Clarks Summit, PA
- Christine Julie Bonczek
- Alexa Krislyn Bonk
- Mari S. Bowen
- Pamela Brace Giannetti
- Daniel Bruining
- Ariana Brutico
- Sokieu Mach Brutico
- Jill A Burke
- Maureen Burke
- Hayley Bush
All providers in Clarks Summit, PA · Foot & Ankle Surgery Podiatrist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.