Individual provider Active NPI

Bryan Dewitt Caldwell, DPM

  • Podiatrist
  • Cleveland, OH
National Provider Identifier
1366448680
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
36 002681 Issued in OH
Practice address
4415 Euclid Ave Ste 110
Cleveland, OH 44103-3759
Phone
(216) 231-5612
Fax
(216) 721-5534
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 36 002681 OH Primary

Addresses

Primary practice location

4415 Euclid Ave Ste 110
Cleveland, OH 44103-3759

Mailing address

4415 Euclid Ave Ste 110
Cleveland, OH 44103-3759
Phone (216) 231-5612

Other identifiers 4

IdentifierTypeStateIssuer
0982227MedicaidOH
1563848OtherOHMEDICAID GROUP
CH5179OtherOHRR MEDICARE GROUP
480031311OtherOHRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100324000176 OH Practitioner - Podiatry 6204961642 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ksu Foot and Ankle ClinicGroup PAC ID 1254588684, 10 clinicians

Practice addresses (Care Compare)

6000 Rockside Woods Blvd
Independence, OH 44131-2330

6000 Rockside Woods Blvd N
Independence, OH 44131-2330
Phone (216) 520-1544

7000 Euclid Ave
Suite 101
Cleveland, OH 44103-4014
Phone (216) 231-5612

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36 002681OHMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ksu Foot & Ankle Clinic Podiatrist CurrentSince Jul 1, 2012 Accepting new patients
Ksu Foot & Ankle Clinic Podiatrist Current Accepting new patients
Barry University Inc PastSince Aug 1, 2019 Accepting new patients

Locations

7000 Euclid Ave
Ste 101
Cleveland, OH 44103
Phone (216) 231-5612

4415 Euclid Ave
Ste 110
Cleveland, OH 44103
Phone (216) 231-5612

6000 Rockside Woods Blvd N
Independence, OH 44131
Phone (216) 231-5612

Interoperability endpoints

  • Direct secure messaging: bryan.caldwell.1@14723.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1366448680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 EUCLID AVE STE 110",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441033759",
            "telephone_number": "216-231-5612",
            "fax_number": "216-721-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 EUCLID AVE STE 110",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441033759",
            "telephone_number": "216-231-5612",
            "fax_number": "216-721-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALDWELL",
        "first_name": "BRYAN",
        "middle_name": "DEWITT",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "36 002681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0982227",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "1563848",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CH5179",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "480031311",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.