Individual provider Active NPI

John Anthony Jackalone, DPM

  • Foot Surgery Podiatrist
  • Bethpage, NY
National Provider Identifier
1174620983
Registry record updated Apr 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
N005711 Issued in NY
Practice address
4295 Hempstead Tpke
Bethpage, NY 11714-5713
Phone
(516) 579-3500
Fax
(516) 579-3802
NPI assigned
Sep 20, 2006
Last updated
Apr 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X N005711 NY Primary

Addresses

Primary practice location

4295 Hempstead Tpke
Bethpage, NY 11714-5713

Mailing address

PO Box 118
Bethpage, NY 11714-0118
Phone (516) 579-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070314000134 NY Practitioner - Podiatry 8527161405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael R. Hutzel, DPM, PLLCGroup PAC ID 5092020933, 3 clinicians

Practice addresses (Care Compare)

4295 Hempstead Tpke
Bethpage, NY 11714-5713
Phone (516) 448-4186

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue495
Removal or shaving of skin growth24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
N005711NYMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R. Hutzel, DPM, PLLC Foot Surgery CurrentSince Nov 1, 2019 Accepting new patients

Locations

4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250

4295 Hempstead Tpke
Ste 5
Bethpage, NY 11714
Phone (516) 605-0205

3650 Merrick Rd
Seaford, NY 11783
Phone (516) 221-5982

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1174620983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 118",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117140118",
            "telephone_number": "516-579-3500",
            "fax_number": "516-579-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4295 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145713",
            "telephone_number": "516-579-3500",
            "fax_number": "516-579-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKALONE",
        "first_name": "JOHN",
        "middle_name": "ANTHONY",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N005711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

Verify at the official NPI Registry.