Active NPI
Julia Dafforn
- Foot & Ankle Surgery Podiatrist
- Bridgeton, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 213ES0103X
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
Practice addresses (Care Compare)
3777 Pecos McLeod
Suite 103
Las Vegas, NV 89121-4265
Phone (702) 434-2023
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 42 |
| Removal or shaving of skin growth | 14 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 213ES0103X | MO | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Podiatry LLC | Foot & Ankle Surgery | Current | Accepting new patients |
| SSM Depaul Health Center Foundation | Current | Accepting new patients | |
| Ryan K Anderson D P M P C | Foot & Ankle Surgery | Current | 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.
-
- Student in an Organized Health Care Education/Training Program
- Bridgeton, MO
- NPI 1407740061
-
- Foot & Ankle Surgery Podiatrist
- Las Vegas, NV
- NPI 1568509016
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.