Chagrin Valley Foot and Ankle Specialists Inc

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

CHAGRIN VALLEY FOOT AND ANKLE SPECIALISTS INC

Practice address

11850 Mayfield Rd
Suite 2
Chardon, OH 44024-8370

Phone

(440) 285-4010

Fax

(877) 561-7535

NPI assigned

Jan 25, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jacquelyn L Quercioli, DPMNPI 1417157082

Title

Owner

Phone

(440) 285-4010

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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.

• Jacquelyn Lee Quercioli, DPM

  • Foot & Ankle Surgery Podiatrist
  • Chardon, OH
  • NPI 1417157082
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1215232137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11850 MAYFIELD RD",
            "address_2": "SUITE 2",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440248370",
            "telephone_number": "440-285-4010",
            "fax_number": "877-561-7535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 MAYFIELD RD",
            "address_2": "SUITE 2",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440248370",
            "telephone_number": "440-285-4010",
            "fax_number": "877-561-7535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAGRIN VALLEY FOOT AND ANKLE SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "QUERCIOLI",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-285-4010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3136172",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatric Clinic/Center in Chardon, OH
• Providers in Chardon, OH by specialty
• Podiatric Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.