Southside Podiatry PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

N004686 Issued in NY

Legal business name

SOUTHSIDE PODIATRY PC

Practice address

903 E 82ND St
Brooklyn, NY 11236

Phone

(718) 241-2000

Fax

(718) 241-5281

NPI assigned

Mar 10, 2007

Organization subpart

No

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

Authorized official

Name

Mark Elliott HupartNPI 1306911680

Title

DPM/President

Phone

(718) 241-2000

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Mark Elliott Hupart, DPM

  • Podiatrist
  • Brooklyn, NY
  • NPI 1306911680
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1205968799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 E 82ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112363811",
            "telephone_number": "718-241-2000",
            "fax_number": "718-241-5281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 E 82ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11236",
            "telephone_number": "718-241-2000",
            "fax_number": "718-241-5281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-10",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "HUPART",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "DPM/PRESIDENT",
        "authorized_official_telephone_number": "718-241-2000"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N002003-1",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N004686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01522036",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01180363",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon South, FNTP
• Nydia Diane Southerland
• Southern Dental
• Angela Grace Southern
• Joyce Lynn Southers, N.P.
• Southwest Brooklyn Dental Practice, PLLC
• Southwest Brooklyn Health Home, LLC
• Southwest Physical Therapy, P.C.
• Caroline Southwick
• Hannah Southworth

• Podiatrist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; 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.