Active NPI
Gold Coast Podiatry Center, LLC
- Foot & Ankle Surgery Podiatrist
- Evanston, IL
National Provider Identifier
1154591048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- Legal business name
- GOLD COAST PODIATRY CENTER, LLC
- Practice address
- 1605 Chicago Ave
Evanston, IL 60201-4504 - Phone
- (847) 424-9888
- Fax
- (847) 424-9649
- NPI assigned
- Mar 6, 2008
- Last updated
- Nov 12, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Fortunee Massuda, DPM
- Title
- Medical Director/Ceo
- Phone
- (773) 752-2111
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | IL | Primary | |
| Foot Surgery Podiatrist | 213ES0131X | IL |
Addresses
Primary practice location
1605 Chicago Ave
Evanston, IL 60201-4504
Mailing address
9933 S Western Ave
Suite 102
Chicago, IL 60643-1810
Phone (773) 233-3800
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Foot & Ankle Surgery Podiatrist
- Chicago, IL
- NPI 1952307019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204761600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1257984000000",
"number": "1154591048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9933 S WESTERN AVE",
"address_2": "SUITE 102",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606431810",
"telephone_number": "773-233-3800",
"fax_number": "773-233-2513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 CHICAGO AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014504",
"telephone_number": "847-424-9888",
"fax_number": "847-424-9649"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOLD COAST PODIATRY CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-03-06",
"last_updated": "2009-11-12",
"status": "A",
"authorized_official_last_name": "MASSUDA",
"authorized_official_first_name": "FORTUNEE",
"authorized_official_title_or_position": "MEDICAL DIRECTOR/CEO",
"authorized_official_telephone_number": "773-752-2111",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "IL",
"license": null,
"primary": true
},
{
"code": "213ES0131X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot Surgery",
"state": "IL",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.