Prairie Podiatry Inc.

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

0700115A Issued in IN

Legal business name

PRAIRIE PODIATRY INC.

Practice address

21813 Cappel LN
Frankfort, IL 60423-2275

Phone

(978) 549-6818

NPI assigned

Apr 10, 2018

Organization subpart

No

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

Authorized official

Name

Wayne McCullough, DPM

Title

President

Phone

(978) 549-6818

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523318400000",
    "number": "1225535867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21813 CAPPEL LN",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604232275",
            "telephone_number": "978-549-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21813 CAPPEL LN",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604232275",
            "telephone_number": "978-549-6818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE PODIATRY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2018-04-10",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-549-6818",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "IN",
            "license": "0700115A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; 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.