Robert Kelvin Woodruff, D.P.M., P.A.

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

80102 Issued in MS

Practice address

3855 Azalea Drive
Jackson, MS 39206-5105

Phone

(601) 366-7063

Fax

(601) 366-7860

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Mississippi Civic Improvement Association, IncGroup PAC ID 4183533235, 48 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr Robert Woodruff DPM PA

  • Foot Surgery Podiatrist
  • Bolton, MS
  • NPI 1083882385

  Foot Surgery, MS

  Medicare reassignment NPD Authorized official
• Central Mississippi Civic Improvement Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1134151442

  MS

  Medicare reassignment
• Central Mississippi Civic Improvement Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1912260522
  NPD
• Central Mississippi Civic Improvement Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1154424554
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1336220177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 HUBB RD",
            "city": "BOLTON",
            "state": "MS",
            "postal_code": "390418500",
            "telephone_number": "601-506-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 AZALEA DRIVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065105",
            "telephone_number": "601-366-7063",
            "fax_number": "601-366-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODRUFF",
        "first_name": "ROBERT",
        "middle_name": "KELVIN",
        "name_prefix": "Dr.",
        "credential": "D.P.M., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "MS",
            "license": "80102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010072",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mattie Woodberry
• Chianti Woodfork, D.D.S.
• Daniel Morse Woodliff, M.D.
• Jill M Woodliff, MD
• Kathy Luper Woodliff, LPC
• Sharon H Woods-Todd, RN.CPAN REGISTERED N
• John Austin Woods, CRNA
• Julia Woods, PHARMD
• Lashunda Woods
• Mark A Woods, OWNER

• All providers in Jackson, MS
• Foot Surgery Podiatrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.