NPIMap

Organization Active NPI

Wellness Podiatry Corp

  • Foot & Ankle Surgery Podiatrist
  • Lincoln, CA
National Provider Identifier
1386462083
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
WELLNESS PODIATRY CORP
Practice address
841 Sterling Pkwy Ste 130
Lincoln, CA 95648-7324
Phone
(916) 434-6410
Fax
(916) 434-6310
NPI assigned
Oct 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Benjamin Van Pham, DPMNPI 1194884387
Title
Owner
Phone
(916) 786-3434

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 SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

841 Sterling Pkwy Ste 130
Lincoln, CA 95648-7324

Mailing address

685 Twelve Bridges Dr Ste F
Lincoln, CA 95648-8689
Phone (916) 786-3434

Other names 1

  • Lincoln Podiatry Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230726004024 CA Part B Supplier - Clinic/Group Practice 4688035439 Receives reassigned benefits from 3 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Auburn, CA; Lincoln, CA; Roseville, CA; Sacramento, CA
O20250606000200 CA DME Supplier - Physician - Podiatry 4688035439 Practice locations: Lincoln, CA

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Wellness Podiatry Corp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1727740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1386462083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 TWELVE BRIDGES DR STE F",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956488689",
            "telephone_number": "916-786-3434",
            "fax_number": "916-786-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 STERLING PKWY STE 130",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956487324",
            "telephone_number": "916-434-6410",
            "fax_number": "916-434-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS PODIATRY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-01",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-786-3434",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Podiatry Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.