NPIMap

Organization Active NPI

Northeast Iowa Podiatry PC

  • Foot & Ankle Surgery Podiatrist
  • Waterloo, IA
National Provider Identifier
1356387799
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
00677 Issued in IA
Legal business name
NORTHEAST IOWA PODIATRY PC
Practice address
44 Brookeridge Dr
Waterloo, IA 50701-5214
Phone
(319) 234-2644
Fax
(319) 234-4938
NPI assigned
Jun 22, 2006
Last updated
Sep 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Authorized official

Name
Dr. Stephen Manning Solomon, DPMNPI 1982699831
Title
President
Phone
(319) 234-2644

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 00677 IA Primary

Addresses

Primary practice location

44 Brookeridge Dr
Waterloo, IA 50701-5214

Mailing address

44 Brookeridge Dr
Waterloo, IA 50701-5214
Phone (319) 234-2644

Other identifiers 2

IdentifierTypeStateIssuer
0208611MedicaidIA
1356387799OtherIAUNITED HEALTHCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000863 IA Part B Supplier - Clinic/Group Practice 7618868530 Receives reassigned benefits from 3 practitioners
Practice locations: New Hampton, IA; Waterloo, IA; Manchester, IA; Grundy Center, IA
O20100930045410 IA DME Supplier - Physician - Podiatry 7618868530 Practice locations: Waterloo, IA

National Provider Directory

National Provider Directory

Locations

709 W Main St
Manchester, IA 52057
Phone (563) 927-3232

44 Brookeridge Dr
Waterloo, IA 50701
Phone (319) 234-2644

Practitioners & affiliated clinicians

Practitioners 9

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": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1356387799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 BROOKERIDGE DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015214",
            "telephone_number": "319-234-2644",
            "fax_number": "319-234-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 BROOKERIDGE DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015214",
            "telephone_number": "319-234-2644",
            "fax_number": "319-234-4938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST IOWA PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "SOLOMON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MANNING",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-234-2644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IA",
            "license": "00677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0208611",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1356387799",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.