John J Distazio, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

SC002842L Issued in PA

Practice address

495 Waterfront Dr E
Suite 230
Homestead, PA 15120-1140

Phone

(412) 461-1108

Fax

(412) 461-5490

NPI assigned

Feb 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• John J Distazio Professional name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• John J Distazio, D.P.M., P.C.

  • Durable Medical Equipment & Medical Supplies
  • Pittsburgh, PA
  • NPI 1831688159
  NPD (past)
• Windber Hospital, Inc.

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271721600000",
    "number": "1366414088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 WATERFRONT DR E",
            "address_2": "SUITE 230",
            "city": "HOMESTEAD",
            "state": "PA",
            "postal_code": "151201140",
            "telephone_number": "412-461-1108",
            "fax_number": "412-461-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 WATERFRONT DR E",
            "address_2": "SUITE 230",
            "city": "HOMESTEAD",
            "state": "PA",
            "postal_code": "151201140",
            "telephone_number": "412-461-1108",
            "fax_number": "412-461-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTAZIO",
        "first_name": "JOHN",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2010-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC002842L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "0004134486",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC PROV NUMBER",
            "identifier": "1156610001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK GRP PROV NUMBER",
            "identifier": "455619",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010941370001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY HMO NUMBER",
            "identifier": "1009921",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC NPI NUMBER",
            "identifier": "1205011277",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP NPI",
            "identifier": "1316123052",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK INDIVIDUAL PROV#",
            "identifier": "175132",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC GROUP PROV NUMBER",
            "identifier": "175132XXX",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MC GROUP NPI NUMBER",
            "identifier": "1316123052",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK GROUP NPI NUMBER",
            "identifier": "1710911912",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "DISTAZIO",
            "middle_name": "J",
            "credential": "DPM, PC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Daniel Crimaldi, RN
• Christine Ramos Dario
• Kaylee Rae Dellert, MS OTR/L
• Kara Jane Dicarlo, LSW
• Rico J Dillard
• Marnie A Divers, RN
• Taresa A Dongilli, CCC-SLP
• Tenell Denise Dorsey
• Drviki LLC
• Annamarie Duboy

• Foot & Ankle Surgery Podiatrist in Homestead, PA
• Providers in Homestead, PA by specialty
• Foot & Ankle Surgery Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; 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.