NPIMap

Organization Active NPI

Shoal Creek Foot and Ankle Center LLC

  • Foot & Ankle Surgery Podiatrist
  • Joplin, MO
National Provider Identifier
1346722055
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
2018010120 Issued in MO
Legal business name
SHOAL CREEK FOOT AND ANKLE CENTER LLC
Practice address
1801 W 32ND St Ste 102
Joplin, MO 64804-1528
Phone
(417) 622-0648
Fax
(417) 622-0497
NPI assigned
Aug 30, 2018
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Dr. Shelly Diane Sedberry, DPMNPI 1770978074
Title
Owner/President
Phone
(417) 622-0648

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)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 2018010120 MO Primary

Addresses

Primary practice location

1801 W 32ND St Ste 102
Joplin, MO 64804-1528

Mailing address

PO Box 4427
Joplin, MO 64803-4427
Phone (417) 622-0648

Other identifiers 1

IdentifierTypeStateIssuer
300054533MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181010000334 MO Part B Supplier - Clinic/Group Practice 0547512154 Receives reassigned benefits from 8 practitioners
Practice locations: Joplin, MO

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Shoal Creek Foot and Ankle Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1801 W 32nd St
Bldg C
Joplin, MO 64804
Phone (417) 622-0648

1801 W 32nd St
Ste 102
Joplin, MO 64804
Phone (417) 622-0648

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1346722055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4427",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648034427",
            "telephone_number": "417-622-0648",
            "fax_number": "417-622-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 32ND ST STE 102",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041528",
            "telephone_number": "417-622-0648",
            "fax_number": "417-622-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOAL CREEK FOOT AND ANKLE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-30",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "SEDBERRY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "417-622-0648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2018010120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300054533",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.

Verify at the official NPI Registry.