First Coast Podiatric Surgery and Wound Care LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO 3294 Issued in FL

Legal business name

FIRST COAST PODIATRIC SURGERY AND WOUND CARE LLC

Practice address

1409 Kingsley Ave
Suite 9-G
Orange Park, FL 32073-4537

Phone

(904) 637-0037

NPI assigned

Jul 29, 2010

Last updated

Mar 1, 2011By 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

Dr. Jorg Alexander Bober, DPMNPI 1720108012

Title

Owner/Podiatrist

Phone

(904) 422-1566

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Tax ID family

First Coast Podiatric Surgery and Wound Care LLC2 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.

• First Coast Podiatric Surgery and Wound Care LLC

  • Foot & Ankle Surgery Podiatrist
  • Jacksonville, FL
  • NPI 1417264722
  NPD tax ID

Locations

Practitioners 2

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.

• Jorg A Bober, DPM

  • Foot & Ankle Surgery Podiatrist
  • Orange Park, FL
  • NPI 1720108012

  Sports Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Arles Jhan L Rustia, DPM

  • Podiatrist
  • Pembroke Pines, FL
  • NPI 1760945109

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1457665663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1653",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320671653",
            "telephone_number": "904-637-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 KINGSLEY AVE",
            "address_2": "SUITE 9-G",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734537",
            "telephone_number": "904-637-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COAST PODIATRIC SURGERY AND WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "BOBER",
        "authorized_official_first_name": "JORG",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "904-422-1566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO 3294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0018B",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002932200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Summer Flack

• Foot & Ankle Surgery Podiatrist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.