Penndoc Foot & Ankle Center, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

SC003540L Issued in PA

Legal business name

PENNDOC FOOT & ANKLE CENTER, LLC

Practice address

133 Mill St
Bradford, PA 16701-1408

Phone

(814) 362-3668

Fax

(814) 362-0540

NPI assigned

Aug 28, 2007

Last updated

Dec 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Holly Foot Eakin

Title

Office Biller

Phone

(181) 436-2366

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/t0FnDeiv5UB5yBJtCG5ByjAAa3LXYuNV/

Practitioners 1

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.

• Gary S Smith, DPM

  • Podiatrist
  • Bradford, PA
  • NPI 1457368862
  Medicare reassignment

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1407040025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "167010040",
            "telephone_number": "814-362-3668",
            "fax_number": "814-362-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 MILL ST",
            "city": "BRADFORD",
            "state": "PA",
            "postal_code": "167011408",
            "telephone_number": "814-362-3668",
            "fax_number": "814-362-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNDOC FOOT & ANKLE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-28",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "EAKIN",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "FOOT",
        "authorized_official_title_or_position": "OFFICE BILLER",
        "authorized_official_telephone_number": "181-436-2366"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC003540L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012260110001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abbey Paulsen, CRNP
• David Peleg, M.D.
• Dana J Pence, PT
• Jacob Burnell Penhollow, FNP-BC
• Penn North Centers for Advanced Wound Care Inc
• Pennsylvania CVS Pharmacy LLC (CVS Pharmacy # 04270)
• Eric Peters, LCSW
• Lori Ann Peterson
• Phoenix Rehabilitation and Health Services, Inc.
• Peter Plummer, PHARMD

• Foot & Ankle Surgery Podiatrist in Bradford, PA
• Providers in Bradford, PA by specialty
• Foot & Ankle Surgery Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.