NPIMap

Organization Active NPI

Claudia R Mallette DPM LLC

  • Foot & Ankle Surgery Podiatrist
  • Melbourne, FL
National Provider Identifier
1154565315
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO 2629 Issued in FL
Legal business name
CLAUDIA R MALLETTE DPM LLC
Practice address
1555 W Nasa Blvd
Melbourne, FL 32901-2640
Phone
(321) 728-0117
Fax
(321) 728-0151
NPI assigned
Apr 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Authorized official

Name
Dr. Claudia R. Mallette, DPMNPI 1861633463
Title
President
Phone
(321) 795-2793

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO 2629 FL Primary

Addresses

Primary practice location

1555 W Nasa Blvd
Melbourne, FL 32901-2640

Mailing address

1555 W Nasa Blvd
Melbourne, FL 32901-2640
Phone (321) 728-0117

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090908000633 FL Part B Supplier - Clinic/Group Practice 2466507827 Receives reassigned benefits from 1 practitioner
Practice locations: Melbourne, FL

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

200 S Harbor City Blvd
Ste 102
Melbourne, FL 32901
Phone (321) 728-0117

Practitioners & affiliated clinicians

Practitioners 2

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": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1154565315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 W NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012640",
            "telephone_number": "321-728-0117",
            "fax_number": "321-728-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 W NASA BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012640",
            "telephone_number": "321-728-0117",
            "fax_number": "321-728-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAUDIA R MALLETTE DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "MALLETTE",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-795-2793",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO 2629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; 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.