Northwest Foot & Ankle Center, PS

Primary specialty

PodiatristTaxonomy code 213E00000X

License

602113454 Issued in WA

Legal business name

NORTHWEST FOOT & ANKLE CENTER, PS

Practice address

4300 Talbot Rd S
Suite 102
Renton, WA 98055-6238

Phone

(425) 277-3668

Fax

(425) 277-0732

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Petrina Celeste Lewis, DPMNPI 1215935457

Title

Owner

Phone

(425) 277-3668

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• NORTHWEST FOOT AND ANKLE CENTER, PS Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Tax ID family

Northwest Foot Ankle Cente2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Northwest Foot and Ankle Center, PS

  • Podiatrist
  • Puyallup, WA
  • NPI 1790963866
  NPD tax ID

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Petrina Celeste Lewis, DPM

  • Podiatrist
  • Scottsdale, AZ
  • NPI 1215935457

  Podiatrist, WA

  Medicare reassignment Care Compare group NPD Authorized official
• Shawn B Khademi, DPM

  • Foot & Ankle Surgery Podiatrist
  • Renton, WA
  • NPI 1124412184

  Single Specialty, WA

  Medicare reassignment Care Compare group NPD
• Mark Thomas Lewis, DPM

  • Podiatrist
  • Renton, WA
  • NPI 1770581910
  Medicare reassignment Care Compare group NPD
• Dustin James Moyer, DPM

  • Foot & Ankle Surgery Podiatrist
  • Renton, WA
  • NPI 1679146229

  Foot & Ankle Surgery, WA

  Medicare reassignment Care Compare group NPD
• Ali Lewann Armstrong Cross, DPM

  • Podiatrist
  • Silverdale, WA
  • NPI 1952755159
  Medicare reassignment NPD
• Jeremy Cross, DPM

  • Podiatrist
  • Silverdale, WA
  • NPI 1407227424
  Medicare reassignment NPD
• Brennan Anthony Menninger, DPM

  • Podiatrist
  • Renton, WA
  • NPI 1407365018

  Multi-Specialty, WA

  Medicare reassignment NPD
• Craig Clifford, DPM

  • Foot & Ankle Surgery Podiatrist
  • Oregon City, OR
  • NPI 1104142686

  Foot & Ankle Surgery

  NPD
• Mallory Schweitzer, DPM

  • Foot & Ankle Surgery Podiatrist
  • Puyallup, WA
  • NPI 1326427584

  Podiatrist

  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1346265261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 TALBOT RD S",
            "address_2": "SUITE 102",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556238",
            "telephone_number": "425-277-3668",
            "fax_number": "425-277-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 TALBOT RD S",
            "address_2": "SUITE 102",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556238",
            "telephone_number": "425-277-3668",
            "fax_number": "425-277-0732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9399 Ridgetop Blvd NW Ste A",
            "address_purpose": "LOCATION",
            "city": "Silverdale",
            "state": "WA",
            "postal_code": "983838505",
            "country_code": "US",
            "telephone_number": "360-900-2626",
            "fax_number": "360-900-2088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11212 Sunrise Blvd E Ste 203",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983748847",
            "country_code": "US",
            "telephone_number": "253-841-4262",
            "fax_number": "253-841-7112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16025 NE 85th St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Redmond",
            "state": "WA",
            "postal_code": "980523551",
            "country_code": "US",
            "telephone_number": "425-439-7005",
            "fax_number": "425-439-7006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST FOOT & ANKLE CENTER, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "PETRINA",
        "authorized_official_middle_name": "CELESTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-277-3668",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WA",
            "license": "602113454",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "156353",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1060272",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST FOOT AND ANKLE CENTER, PS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Renton, WA
• Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.