Individual provider Active NPI

Scott Michael De Wenter, DPM

  • Podiatrist
  • Lake Elsinore, CA
National Provider Identifier
1376569194
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4080 Issued in CA
Practice address
600 Central Ave
Ste G
Lake Elsinore, CA 92530-2740
Phone
(951) 245-7472
Fax
(951) 674-1156
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E4080 CA Primary

Addresses

Primary practice location

600 Central Ave
Ste G
Lake Elsinore, CA 92530-2740

Mailing address

600 Central Ave
Ste G
Lake Elsinore, CA 92530-2740
Phone (951) 245-7472

Other identifiers 1

IdentifierTypeStateIssuer
000E40800MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20110218000403 CA Practitioner - Podiatry 6305027764 Reassigns benefits to 1 organization
Practice locations: Hemet, CA; Lake Elsnore, CA; Murrieta, CA; Sun City, CA; Temecula, CA; Temeculla, CA; Wildomar, CA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

600 Central Ave
Ste. G
Lake Elsnore, CA 92530-2740
Phone (951) 245-7472

600 Central Ave G
Lake Elsinore, CA 92530-2740

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue960
Removal or shaving of skin growth77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4080CAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Socal Foot Care PC Podiatrist CurrentSince Feb 1, 2025 Accepting new patients
Socal Foot Care PC Podiatrist CurrentSince Feb 1, 2025 Accepting new patients
Pacifica Menifee Valley Opco LP PastSince Apr 9, 2024 Accepting new patients
The Springwood Podiatry Group, a Profesional Corporation Podiatrist Past Accepting new patients
Joseph Nevarez MD CWS Inc Past Accepting new patients
Orthopaedic and Neurological Rehabilitation, Speech Pathology, Inc Past Accepting new patients
Bradley Road Holdings LLC PastSince Apr 9, 2024 Accepting new patients

Locations

255 N Gilbert St
Ste B1
Hemet, CA 92543
Phone (951) 652-4386

9850 Genesee Ave
Ste 510
La Jolla, CA 92037
Phone (858) 450-9218

28078 Baxter Rd
Ste 424
Murrieta, CA 92563
Phone (951) 679-1020

39755 Murrieta Hot Springs Rd
Ste D130
Murrieta, CA 92563
Phone (951) 698-4611

Interoperability endpoints

  • Direct secure messaging: scott.dewenter.1@20181.direct.athenahealth.com

Organizations & group practices 7

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376569194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CENTRAL AVE",
            "address_2": "STE G",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302740",
            "telephone_number": "951-245-7472",
            "fax_number": "951-674-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CENTRAL AVE",
            "address_2": "STE G",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302740",
            "telephone_number": "951-245-7472",
            "fax_number": "951-674-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE WENTER",
        "first_name": "SCOTT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E40800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Elsinore, CA

Sources for this page

Verify at the official NPI Registry.