NPIMap

Organization Active NPI

Lakeside Foot Clinic, PC

  • Podiatrist
  • Cornelius, NC
National Provider Identifier
1184884777
Registry record updated Mar 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
270 Issued in NC
Legal business name
LAKESIDE FOOT CLINIC, PC
Practice address
19453 W Catawba Ave Ste a
Cornelius, NC 28031-4022
Phone
(704) 892-3399
Fax
(704) 892-5113
NPI assigned
Jun 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2015

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

Authorized official

Name
Dr. John Michael Shimko, DPM
Title
Sole Proprietor
Phone
(704) 892-3399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 270 NC Primary

Addresses

Primary practice location

19453 W Catawba Ave Ste a
Cornelius, NC 28031-4022

Mailing address

19453 W Catawba Ave Ste a
Cornelius, NC 28031-4022
Phone (704) 892-3399

Other identifiers 2

IdentifierTypeStateIssuer
890816HMedicaidNC
0816HOtherNCBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

19453 W Catawba Ave
Ste A
Cornelius, NC 28031
Phone (704) 892-3399

Practitioners & affiliated clinicians

Practitioners 4

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": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427068800000",
    "number": "1184884777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19453 W CATAWBA AVE STE A",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314022",
            "telephone_number": "704-892-3399",
            "fax_number": "704-892-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19453 W CATAWBA AVE STE A",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314022",
            "telephone_number": "704-892-3399",
            "fax_number": "704-892-5113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FOOT CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2015-03-23",
        "status": "A",
        "authorized_official_last_name": "SHIMKO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "704-892-3399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "NC",
            "license": "270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890816H",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0816H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.