Active NPI
Affiliated Foot Care Center, LLC
- Podiatrist
- Middlefield, CT
National Provider Identifier
1295807451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 000723
- Legal business name
- AFFILIATED FOOT CARE CENTER, LLC
- Practice address
- 470 Main St
Middlefield, CT 06455-1210 - Phone
- (860) 349-8500
- Fax
- (860) 349-3081
- NPI assigned
- Nov 14, 2006
- Last updated
- Jan 27, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Gordon E Fosdick, DPM
- Title
- Owner/Physician
- Phone
- (860) 349-8500
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 000723 | CT | Primary |
Addresses
Primary practice location
470 Main St
Middlefield, CT 06455-1210
Mailing address
470 Main St
Middlefield, CT 06455-1210
Phone (860) 349-8500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004206951 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
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.
-
- Foot Surgery Podiatrist
- Middlefield, CT
- NPI 1740206192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1580083200000",
"number": "1295807451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 MAIN ST",
"city": "MIDDLEFIELD",
"state": "CT",
"postal_code": "064551210",
"telephone_number": "860-349-8500",
"fax_number": "860-349-3081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 MAIN ST",
"city": "MIDDLEFIELD",
"state": "CT",
"postal_code": "064551210",
"telephone_number": "860-349-8500",
"fax_number": "860-349-3081"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AFFILIATED FOOT CARE CENTER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-14",
"last_updated": "2020-01-27",
"certification_date": "2020-01-27",
"status": "A",
"authorized_official_last_name": "FOSDICK",
"authorized_official_first_name": "GORDON",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "OWNER/PHYSICIAN",
"authorized_official_telephone_number": "860-349-8500",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "CT",
"license": "000723",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004206951",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middlefield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.