NPIMap

Individual provider Active NPI

Allen A Dzambo Jr., M.D.

  • Foot & Ankle Surgery Podiatrist
  • Latrobe, PA
National Provider Identifier
1174503791
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
SC004642L Issued in PA
Practice address
1200 Jefferson St
Latrobe, PA 15650-1915
Phone
(724) 539-3444
Fax
(724) 539-4133
NPI assigned
Jan 19, 2006
Last updated
Dec 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X SC004642L PA Primary

Addresses

Primary practice location

1200 Jefferson St
Latrobe, PA 15650-1915

Mailing address

1200 Jefferson St
Latrobe, PA 15650-1915
Phone (724) 539-3444

Other identifiers 3

IdentifierTypeStateIssuer
0017663730004MedicaidPA
001799222OtherPABLUE SHIELD
0017663730003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060220000521 PA Practitioner - Podiatry 5890700330 Reassigns benefits to 1 organization
Practice locations: Latrobe, PA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

530 S St
Greensburg, PA 15601-2775
Phone (724) 830-8527

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue234

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01329MDMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Allen a. Dzambo, Jr., DPM Foot & Ankle Surgery CurrentSince Jan 1, 1990 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Excela Health Physician Practices, Inc Current Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Hutt Podiatry Inc PastSince Aug 7, 2014 Accepting new patients
Excela Health Physician Practices, Inc Past Accepting new patients

Locations

530 South St
Greensburg, PA 15601
Phone (724) 830-8527

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

1 Mellon Way
Latrobe, PA 15650
Phone (724) 537-1207

1 Mellon Way
Fl 3
Latrobe, PA 15650
Phone (724) 539-3870

1200 Jefferson St
Latrobe, PA 15650
Phone (724) 539-3444

490 S Church St
Mt Pleasant, PA 15666
Phone (724) 542-1930

Interoperability endpoints

  • Direct secure messaging: adzambo@direct.excelahealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1174503791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 JEFFERSON ST",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156501915",
            "telephone_number": "724-539-3444",
            "fax_number": "724-539-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 JEFFERSON ST",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156501915",
            "telephone_number": "724-539-3444",
            "fax_number": "724-539-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZAMBO",
        "first_name": "ALLEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC004642L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017663730004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "001799222",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017663730003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Latrobe, PA

Sources for this page

Verify at the official NPI Registry.