NPIMap

Organization Active NPI

Make Yourself, LLC

  • Foot Surgery Podiatrist
  • Peru, IN
National Provider Identifier
1174020549
Registry record updated Apr 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
07000906A Issued in IN
Legal business name
MAKE YOURSELF, LLC
Practice address
128 W 5TH St
Peru, IN 46970-2139
Phone
(765) 244-7440
NPI assigned
Apr 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2018

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

Authorized official

Name
Bradley R Hammersley, DPMNPI 1295780872
Title
Owner
Phone
(765) 244-7440

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 Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X 07000906A IN Primary

Addresses

Primary practice location

128 W 5TH St
Peru, IN 46970-2139

Mailing address

128 W 5TH St
Peru, IN 46970-2139
Phone (765) 244-7440

Other names 1

  • Sole Source Podiatry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1523404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523404800000",
    "number": "1174020549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 W 5TH ST",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469702139",
            "telephone_number": "765-244-7440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 W 5TH ST",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469702139",
            "telephone_number": "765-244-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKE YOURSELF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-11",
        "last_updated": "2018-04-11",
        "status": "A",
        "authorized_official_last_name": "HAMMERSLEY",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-244-7440",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "IN",
            "license": "07000906A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sole Source Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peru, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.