NPIMap

Organization Active NPI

Orthotic & Prosthetic Clinic Inc

  • Prosthetic/Orthotic Supplier
  • Port St Lucie, FL
National Provider Identifier
1396757175
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
ORTHOTIC & PROSTHETIC CLINIC INC
Practice address
1701 SE Hillmoor Dr
C13
Port St Lucie, FL 34952-7552
Phone
(772) 337-7378
Fax
(772) 337-1742
NPI assigned
Aug 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. James R Fenton, CPONPI 1760489868
Title
Owner President
Phone
(772) 337-7378

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
Prosthetic/Orthotic Supplier 335E00000X FL Primary

Addresses

Primary practice location

1701 SE Hillmoor Dr
C13
Port St Lucie, FL 34952-7552

Mailing address

1701 SE Hillmoor Dr
C13
Port St Lucie, FL 34952-7552
Phone (772) 337-7378

Other names 1

  • Fenton Prosthetics & Orthotics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930005863 FL DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 0941321590 Practice locations: Port Saint Lucie, FL

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Orthotic and Prosthetic Clinic Inc1701 SE Hillmoor Dr, Port Saint Lucie, FL 34952-7540(772) 337-7378 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Fenton Prosthetics Orthotics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1701 SE Hillmoor Dr
Ste C13
Port St Lucie, FL 34952
Phone (772) 337-7378

Practitioners & affiliated clinicians

Practitioners 2

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": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396757175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "C13",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-337-7378",
            "fax_number": "772-337-1742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SE HILLMOOR DR",
            "address_2": "C13",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527552",
            "telephone_number": "772-337-7378",
            "fax_number": "772-337-1742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOTIC & PROSTHETIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "FENTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "772-337-7378",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fenton Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.