Advanced Ankle and Foot Surgeons, LLC
Organization Active NPI Podiatrist · O Fallon, IL
NPI 1275773293 · NPPES record last updated Apr 21, 2025
Key facts
- NPI
- 1275773293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- License
- 016.004852 (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
- Mar 3, 2009
- Organization subpart
- No
Authorized official
- Name
- Michele Taylor, JD
- Title
- Cfo
- Phone
- (618) 277-0001
Practitioners 6
-
Christian Elias Czech, FNP-C
-
Kendra Jane Green, FNP-C
-
Bryan F Guignon, DPM
-
Ashley Taylor McIntyre, FNP-C
-
James Drew Taylor, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090430000454 | IL | Part B Supplier - Clinic/Group Practice | 2769530740 |
Receives reassigned benefits from 6 practitioners Practice locations: New Baden, IL; O'Fallon, IL |
| O20100930022827 | IL | DME Supplier - Physician - Podiatry | 2769530740 | Practice locations: O Fallon, IL |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | 016.004852 | IL | Yes |
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
311 E Hanover St
New Baden, IL 62265-1813
Phone (618) 277-0001
Other names
- Affiliated Ankle and Foot Surgeons
Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.