NPIMap

Organization Active NPI

Polun Family Footcare P C

  • Podiatrist
  • Owings Mills, MD
National Provider Identifier
1174615173
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
POLUN FAMILY FOOTCARE P C
Practice address
19 Beecham CT
Owings Mills, MD 21117-6001
Phone
(410) 654-8602
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Authorized official

Name
Benjamin Silverman
Title
Accountant
Phone
(410) 654-8602

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

19 Beecham CT
Owings Mills, MD 21117-6001

Mailing address

19 Beecham CT
Owings Mills, MD 21117-6001
Phone (410) 654-8602

Other identifiers 2

IdentifierTypeStateIssuer
4426119MedicaidDC
524101402MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050912000584 MD Part B Supplier - Clinic/Group Practice 7315928918 Receives reassigned benefits from 1 practitioner
Practice locations: Baltimore, MD; Lutherville, MD; Reistertown, MD

National Provider Directory

National Provider Directory

Locations

109 Forest Valley Dr
Forest Hill, MD 21050
Phone (410) 776-6038

9910 River Rd
Potomac, MD 20854
Phone (301) 299-0612

10910 Old Georgetown Rd
Rockville, MD 20852
Phone (301) 530-1534

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549843200000",
    "number": "1174615173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BEECHAM CT",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211176001",
            "telephone_number": "410-654-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BEECHAM CT",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211176001",
            "telephone_number": "410-654-8602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLUN FAMILY FOOTCARE P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2019-02-11",
        "status": "A",
        "authorized_official_last_name": "SILVERMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "410-654-8602"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4426119",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524101402",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; 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.