NPIMap

Organization Active NPI

Laser Podiatry Associates, LLC

  • Foot & Ankle Surgery Podiatrist
  • Frederick, MD
National Provider Identifier
1386943561
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
LASER PODIATRY ASSOCIATES, LLC
Practice address
182 Thomas Johnson Dr Ste 204
Frederick, MD 21702-4557
Phone
(301) 695-9669
Fax
(301) 695-0346
NPI assigned
Mar 27, 2011
Last updated
Dec 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Authorized official

Name
Jennifer E Mullendore, DPMNPI 1912902545
Title
Owner
Phone
(301) 695-9669

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 Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

182 Thomas Johnson Dr Ste 204
Frederick, MD 21702-4557

Mailing address

198 Thomas Johnson Dr
Suite 4
Frederick, MD 21702-4398
Phone (301) 695-9669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120314000085 MD Part B Supplier - Clinic/Group Practice 0345409181 Receives reassigned benefits from 1 practitioner
Practice locations: Frederick, MD; Mount Airy, MD
O20130829000847 MD DME Supplier - Physician - Podiatry 0345409181 Practice locations: Frederick, MD

National Provider Directory

National Provider Directory

Locations

1001 Twin Arch Rd
Ste B3
Mount Airy, MD 21771
Phone (301) 695-1013

1604 Ridgeside Dr
Mount Airy, MD 21771

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1301184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577059200000",
    "number": "1386943561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 THOMAS JOHNSON DR",
            "address_2": "SUITE 4",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024398",
            "telephone_number": "301-695-9669",
            "fax_number": "301-695-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 THOMAS JOHNSON DR STE 204",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024557",
            "telephone_number": "301-695-9669",
            "fax_number": "301-695-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASER PODIATRY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-27",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A",
        "authorized_official_last_name": "MULLENDORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-695-9669",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; 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.