NPIMap

Organization Active NPI

Orange County Foot & Ankle Group, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Tustin, CA
National Provider Identifier
1396929774
Registry record updated Dec 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E4301 Issued in CA
Legal business name
ORANGE COUNTY FOOT & ANKLE GROUP, INC.
Practice address
17400 Irvine Blvd
Suite J
Tustin, CA 92780-3030
Phone
(714) 832-0271
Fax
(714) 832-0272
NPI assigned
Dec 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2007

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

Authorized official

Name
Mr. Jonathan Ian Bennett, DPMNPI 1497850325
Title
President
Phone
(714) 832-0271

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 E4301 CA Primary

Addresses

Primary practice location

17400 Irvine Blvd
Suite J
Tustin, CA 92780-3030

Mailing address

17400 Irvine Blvd
Suite J
Tustin, CA 92780-3030
Phone (714) 832-0271

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040831000544 CA Part B Supplier - Clinic/Group Practice 1658346978 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tustin, CA; Santa Ana, CA; Fullerton, CA

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

Locations

17400 Irvine Blvd
Ste J
Tustin, CA 92780
Phone (714) 832-0271

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1396929774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17400 IRVINE BLVD",
            "address_2": "SUITE J",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803030",
            "telephone_number": "714-832-0271",
            "fax_number": "714-832-0272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17400 IRVINE BLVD",
            "address_2": "SUITE J",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803030",
            "telephone_number": "714-832-0271",
            "fax_number": "714-832-0272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE COUNTY FOOT & ANKLE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-832-0271",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.