NPIMap

Organization Active NPI

Advanced Ankle and Foot Surgeons, LLC

  • Podiatrist
  • O'Fallon, IL
National Provider Identifier
1245563501
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016.004852 Issued in IL
Legal business name
ADVANCED ANKLE AND FOOT SURGEONS, LLC
Practice address
4905 Stone Falls Ctr Ste B
O Fallon, IL 62269-7802
Phone
(618) 277-0001
Fax
(618) 277-7339
NPI assigned
Sep 17, 2009
Last updated
May 29, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Authorized official

Name
Michele Taylor, JD
Title
Cfo
Phone
(618) 960-1836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016.004852 IL Primary

Addresses

Primary practice location

4905 Stone Falls Ctr Ste B
O Fallon, IL 62269-7802

Mailing address

4905 Stone Falls Ctr Ste B
O Fallon, IL 62269-7802
Phone (618) 277-0001

Other practice location 1

4600 Memorial Dr Ste 80
Belleville, IL 62226-5359
Phone (618) 277-0001

Other practice location 2

4905 Stone Falls Ctr Ste B
O Fallon, IL 62269-7802
Phone (618) 277-0001

Other identifiers 1

IdentifierTypeStateIssuer
6242980002OtherILPTAN

National Provider Directory

National Provider Directory

Locations

4600 Memorial Dr
Ste 80
Belleville, IL 62226
Phone (618) 277-0001

4905 Stone Falls Ctr
#B
O Fallon, IL 62269
Phone (618) 277-0001

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1245563501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 STONE FALLS CTR STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697802",
            "telephone_number": "618-277-0001",
            "fax_number": "618-277-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 STONE FALLS CTR STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697802",
            "telephone_number": "618-277-0001",
            "fax_number": "618-277-7339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 Memorial Dr Ste 80",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622265359",
            "country_code": "US",
            "telephone_number": "618-277-0001",
            "fax_number": "618-277-7339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4905 Stone Falls Ctr Ste B",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622697802",
            "country_code": "US",
            "telephone_number": "618-277-0001",
            "fax_number": "618-277-7339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED ANKLE AND FOOT SURGEONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-17",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-960-1836",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016.004852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "6242980002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; 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.