Russell A. Grootegoed, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E2064 Issued in CA

Practice address

601 W 9TH St
San Pedro, CA 90731-3107

Phone

(310) 833-3583

Fax

(310) 833-1976

NPI assigned

Jun 13, 2006

Last updated

Apr 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Russell a. Grootegoed DPM

  • Prosthetic/Orthotic Supplier
  • San Pedro, CA
  • NPI 1720261118
  NPD (past) Authorized official

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1194767921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W 9TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313107",
            "telephone_number": "310-833-3583",
            "fax_number": "310-833-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W 9TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313107",
            "telephone_number": "310-833-3583",
            "fax_number": "310-833-1976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROOTEGOED",
        "first_name": "RUSSELL",
        "middle_name": "A.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CA",
            "license": "E2064",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E2064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "953239247",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E2064000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shateo Griffin
• Stephanie Teresa Griffin
• Shannon Frances Griswold, PSY.D.
• Christopher A Groat, D.D.S.
• Geoffrey Groat, D.D.S.
• Catrina Elaine Grove
• GS Medical Center Inc
• Guedea Chiropractic, Inc.
• Miguel Antonio Guedea, D.C.
• Leonor Guerrero

• Foot & Ankle Surgery Podiatrist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.