Active NPI
Foot & Ankle Institute of Sports Medicine, LLC
- Foot & Ankle Surgery Podiatrist
- Port Huron, MI
National Provider Identifier
1336835875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- Legal business name
- FOOT & ANKLE INSTITUTE OF SPORTS MEDICINE, LLC
- Practice address
- 1107 Stone St Ste 3
Port Huron, MI 48060-3569 - Phone
- (810) 204-4494
- Fax
- (810) 479-9640
- NPI assigned
- Apr 17, 2023
- 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
- Rachelle Randall, DPM
- Title
- Coo
- Phone
- (810) 650-7113
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 |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | Primary |
Addresses
Primary practice location
1107 Stone St Ste 3
Port Huron, MI 48060-3569
Mailing address
1107 Stone St Ste 3
Port Huron, MI 48060-3569
Phone (810) 204-4494
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider DirectoryInteroperability endpoints
- https://drchrono-fhirpresentation.everhealthsoftware.com/fhir/drchrono/505041/r4
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Port Huron, MI
- NPI 1306619481
-
- Family Medicine Physician
- Port Huron, MI
- NPI 1871569798
-
- Family Nurse Practitioner
- Port Huron, MI
- NPI 1780312470
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681689600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1739232000000",
"number": "1336835875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 STONE ST STE 3",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603569",
"telephone_number": "810-204-4494",
"fax_number": "810-479-9640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1107 STONE ST STE 3",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603569",
"telephone_number": "810-204-4494",
"fax_number": "810-479-9640"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOOT & ANKLE INSTITUTE OF SPORTS MEDICINE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-04-17",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A",
"authorized_official_last_name": "RANDALL",
"authorized_official_first_name": "RACHELLE",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "810-650-7113",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.