Ankle & Foot Specialists of Puget Sound, PS
Organization Active NPI Podiatrist · Bellevue, WA
NPI 1346548658 · NPPES record last updated Jul 24, 2012
Key facts
- NPI
- 1346548658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
- Practice address
- 4140 Factoria Blvd SE
Suite 1B
Bellevue, WA 98006-5261 - Phone
- (425) 644-2313
- Fax
- (425) 644-4739
- NPI assigned
- Mar 10, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Authorized official
- Name
- Charles R Chu, DPM
- Title
- Owner
- Phone
- (425) 449-2471
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 11
Practitioners 6
-
Ryan Alan Bierman, DPM
-
Bryan Le Holand, DPM
-
Lance Alfred Nethercott, D.P.M.
-
Joshua T Smith, DPM
-
Ronald S Sorensen, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040218000487 | WA | Part B Supplier - Clinic/Group Practice | 7214822253 |
Receives reassigned benefits from 7 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Puyallup, WA; Redmond, WA; Issaquah, WA; Enumclaw, WA; Covington, WA; Bonney Lake, WA; Bellevue, WA |
| O20120524000125 | WA | DME Supplier - Physician - General Practice | 7214822253 | Practice locations: Bellevue, WA |
National Provider Directory
- Tax ID family
- Factoria Foot and Ankle
- Part of
- Factoria Foot and Ankle
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes | ||
| Primary Podiatric Medicine Podiatrist |
213EP1101X | |||
| Foot & Ankle Surgery Podiatrist |
213ES0103X |
Addresses
Primary practice location
4140 Factoria Blvd SE
Suite 1B
Bellevue, WA 98006-5261
Mailing address
2728 E Main
Suite a
Puyallup, WA 98372-3198
Phone (253) 841-2006
Other names
- Factoria Foot & Ankle Clinic
Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.