NPIMap

Organization Active NPI

Foot and Ankle Care of Boulder County

  • Foot & Ankle Surgery Podiatrist
  • Boulder, CO
National Provider Identifier
1376239293
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
FOOT AND ANKLE CARE OF BOULDER COUNTY
Practice address
1400 28TH St Ste 2
Boulder, CO 80303-1096
Phone
(303) 449-2000
Fax
(303) 449-9475
NPI assigned
Apr 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Authorized official

Name
Brian Gradisek, DPMNPI 1700178092
Title
Owner
Phone
(303) 449-2000

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 PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1400 28TH St Ste 2
Boulder, CO 80303-1096

Mailing address

1400 28TH St Ste 2
Boulder, CO 80303-1096
Phone (303) 449-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230503002659 CO Part B Supplier - Clinic/Group Practice 4789049339 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Boulder, CO; Greeley, CO
O20230927004118 CO DME Supplier - Physician - Podiatry 4789049339 Practice locations: Boulder, CO

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Foot and Ankle Care of Boulder County3 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.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681344000000",
    "number": "1376239293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 28TH ST STE 2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031096",
            "telephone_number": "303-449-2000",
            "fax_number": "303-449-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 28TH ST STE 2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031096",
            "telephone_number": "303-449-2000",
            "fax_number": "303-449-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE CARE OF BOULDER COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-07",
        "status": "A",
        "authorized_official_last_name": "GRADISEK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-449-2000",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; 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.