Individual provider Active NPI

Julia Dafforn

  • Foot & Ankle Surgery Podiatrist
  • Bridgeton, MO
National Provider Identifier
1235868860
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
213ES0103X Issued in MO
Practice address
12255 Depaul Drive
Ste 705
Bridgeton, MO 63044
Phone
(314) 344-7545
NPI assigned
Jun 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 213ES0103X MO Primary

Addresses

Primary practice location

12255 Depaul Drive
Ste 705
Bridgeton, MO 63044

Mailing address

138 Hemstead St
Lake Bluff, IL 60044-1155
Phone (760) 662-1292

Other practice location 1

12303 depaul drive
brideton, MO 63044
Phone (314) 344-7545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251030002726 NV Practitioner - Podiatry 3476042367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ryan K Anderson D P M P CGroup PAC ID 7517999121, 51 clinicians

Practice addresses (Care Compare)

3777 Pecos McLeod
Suite 103
Las Vegas, NV 89121-4265
Phone (702) 434-2023

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue42
Removal or shaving of skin growth14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
213ES0103XMOMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Podiatry LLC Foot & Ankle Surgery CurrentSince Aug 17, 2025 Accepting new patients
SSM Depaul Health Center Foundation CurrentSince Jun 8, 2025 Accepting new patients
Ryan K Anderson D P M P C Foot & Ankle Surgery CurrentSince Aug 17, 2025 Accepting new patients

Locations

3777 Pecos McLeod
Ste 103
Las Vegas, NV 89121
Phone (702) 324-2713

434 W Ascension Way
Ste 425
Salt Lake City, UT 84123

596 W 750 S
Ste 300
Woods Cross, UT 84010
Phone (801) 673-7661

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1235868860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 HEMSTEAD ST",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600441155",
            "telephone_number": "760-662-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DEPAUL DRIVE",
            "address_2": "STE 705",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-344-7545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12303 depaul drive",
            "address_purpose": "LOCATION",
            "city": "brideton",
            "state": "MO",
            "postal_code": "63044",
            "country_code": "US",
            "telephone_number": "314-344-7545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAFFORN",
        "first_name": "JULIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "213ES0103X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.