NPIMap

Organization Active NPI

Northwest Footcare, LLC

  • Podiatrist
  • Bend, OR
National Provider Identifier
1275545311
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
NORTHWEST FOOTCARE, LLC
Practice address
1693 SW Chandler Ave
Ste 280
Bend, OR 97702
Phone
(541) 385-7129
Fax
(541) 385-7138
NPI assigned
Aug 13, 2006
Last updated
Feb 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Authorized official

Name
Bryan D Wilhelm, DPMNPI 1427060565
Title
Managing Physician
Phone
(541) 385-7129

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

1693 SW Chandler Ave
Ste 280
Bend, OR 97702

Mailing address

1693 SW Chandler Ave
Ste 280
Bend, OR 97702
Phone (541) 385-7129

Other identifiers 3

IdentifierTypeStateIssuer
DD4584OtherORRAILROAD MEDICARE
865318000OtherORBLUE CROSS
213406MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050518001004 OR Part B Supplier - Clinic/Group Practice 7113968256 Receives reassigned benefits from 4 practitioners
Practice locations: Bend, OR; La Pine, OR
O20100930099019 OR DME Supplier - Physician - Podiatry 7113968256 Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

1510 SW Nancy Way
Ste 2
Bend, OR 97702
Phone (541) 385-7129

630 S J St
Lakeview, OR 97630
Phone (541) 385-7129

Practitioners & affiliated clinicians

Practitioners 11

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": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1275545311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1693 SW CHANDLER AVE",
            "address_2": "STE 280",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-385-7129",
            "fax_number": "541-385-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1693 SW CHANDLER AVE",
            "address_2": "STE 280",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-385-7129",
            "fax_number": "541-385-7138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FOOTCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "WILHELM",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "541-385-7129",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD4584",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "865318000",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213406",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.