NPIMap

Organization Active NPI

Podomedik LLC

  • Foot & Ankle Surgery Podiatrist
  • Waukegan, IL
National Provider Identifier
1215043310
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
911025 Issued in WI
Legal business name
PODOMEDIK LLC
Practice address
2634 Grand Ave Ste 102a
Waukegan, IL 60085-2459
Phone
(847) 249-3888
NPI assigned
Aug 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Authorized official

Name
Dr. Gerardo Perez-Espindola, DPMNPI 1568456374
Title
Physician
Phone
(856) 520-4513

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 911025 WI Primary

Addresses

Primary practice location

2634 Grand Ave Ste 102a
Waukegan, IL 60085-2459

Mailing address

2634 Grand Ave Ste 102a
Waukegan, IL 60085-2459
Phone (847) 249-3888

Other identifiers 2

IdentifierTypeStateIssuer
43241500MedicaidWI
30-6095164OtherTAX ID

Other names 1

  • Carmen Sebastian-Novell Doing business as

National Provider Directory

National Provider Directory

Locations

2634 Grand Ave
Ste 102A
Waukegan, IL 60085
Phone (847) 249-3888

Practitioners & affiliated clinicians

Practitioners 1

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": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1215043310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2634 GRAND AVE STE 102A",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852459",
            "telephone_number": "847-249-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2634 GRAND AVE STE 102A",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852459",
            "telephone_number": "847-249-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODOMEDIK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "PEREZ-ESPINDOLA",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "856-520-4513",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WI",
            "license": "911025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43241500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "30-6095164",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carmen Sebastian-Novell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.