NPIMap

Organization Active NPI

Foot & Ankle Specialists of Arizona PLLC

  • Foot & Ankle Surgery Podiatrist
  • Glendale, AZ
National Provider Identifier
1316504574
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
FOOT & ANKLE SPECIALISTS OF ARIZONA PLLC
Practice address
18301 N 79TH Ave Ste F168
Glendale, AZ 85308-6045
Phone
(623) 544-9090
Fax
(623) 546-3704
NPI assigned
May 23, 2019
Last updated
Dec 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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

Authorized official

Name
Seth Clark, DPMNPI 1669811915
Title
Owner
Phone
(623) 544-9090

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
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary
Non-Pharmacy Dispensing Site 332900000X NU

Addresses

Primary practice location

18301 N 79TH Ave Ste F168
Glendale, AZ 85308-6045

Mailing address

18301 N 79TH Ave Ste F168
Glendale, AZ 85308-6045
Phone (623) 544-9090

Other practice location 1

5681 W Beverly Ln Ste 100A
Glendale, AZ 85306-9800
Phone (623) 544-9090

Other practice location 2

4550 E Bell Rd Ste 170
Phoenix, AZ 85032-9385
Phone (623) 544-9090

Other practice location 3

10615 W Thunderbird Blvd Ste B100
Sun City, AZ 85351-2748
Phone (623) 544-9090

Other practice location 4

13949 W Meeker Blvd Ste B
Sun City West, AZ 85375-4436
Phone (602) 675-0478

Other practice location 5

10615 W Thunderbird Blvd # C150
Sun City, AZ 85351-3033
Phone (623) 544-9090

Other practice location 6

519 Rose Ln
Wickenburg, AZ 85390-1448
Phone (623) 544-9090

Other practice location 7

519 Rose Ln
Wickenburg, AZ 85390-1448
Phone (623) 544-9090

Other practice location 8

490 W Bralliar Rd
Wickenburg, AZ 85390-2448
Phone (623) 544-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191122001947 AZ Part B Supplier - Clinic/Group Practice 7113359555 Receives reassigned benefits from 15 practitioners
Practice locations: Wickenburg, AZ; Sun City West, AZ; Sun City, AZ; Phoenix, AZ; Glendale, AZ
O20200331003655 AZ DME Supplier - Physician - Podiatry 7113359555 Practice locations: Glendale, AZ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Foot Ankle Specialists of6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5681 W Beverly Ln
Ste 100A
Glendale, AZ 85306

926 E McDowell Rd
Ste 121
Phoenix, AZ 85006
Phone (602) 340-8686

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1316504574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE F168",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086045",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE F168",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086045",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5681 W Beverly Ln Ste 100A",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853069800",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4550 E Bell Rd Ste 170",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850329385",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10615 W Thunderbird Blvd Ste B100",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853512748",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13949 W Meeker Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853754436",
            "country_code": "US",
            "telephone_number": "602-675-0478",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10615 W Thunderbird Blvd # C150",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853513033",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "519 Rose Ln",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853901448",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "519 Rose Ln",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853901448",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "490 W Bralliar Rd",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853902448",
            "country_code": "US",
            "telephone_number": "623-544-9090",
            "fax_number": "623-546-3704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOOT & ANKLE SPECIALISTS OF ARIZONA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-544-9090",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.