NPIMap

Organization Active NPI

Cumberland Foot and Ankle Center

  • Foot & Ankle Surgery Podiatrist
  • Williamsburg, KY
National Provider Identifier
1467768747
Registry record updated Aug 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
CUMBERLAND FOOT AND ANKLE CENTER
Practice address
475 N Highway 25 W
Suite 101
Williamsburg, KY 40769-1576
Phone
(606) 679-2773
Fax
(606) 679-4626
NPI assigned
Aug 25, 2010
Last updated
Aug 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2010

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

Authorized official

Name
Jonathan E Moore, DPMNPI 1558339440
Title
Owner/Podiatrist
Phone
(606) 679-2773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X Primary

Addresses

Primary practice location

475 N Highway 25 W
Suite 101
Williamsburg, KY 40769-1576

Mailing address

117 Tradepark Dr
Somerset, KY 42503-3428
Phone (606) 679-2773

Other identifiers 1

IdentifierTypeStateIssuer
90005091MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322000214 KY Part B Supplier - Clinic/Group Practice 4385535319 Receives reassigned benefits from 24 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowling Green, KY; Somerset, KY; Russell Springs, KY; Richmond, KY; Mount Vernon, KY; Monticello, KY; Manchester, KY; London, KY…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282694400000",
    "number": "1467768747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 TRADEPARK DR",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033428",
            "telephone_number": "606-679-2773",
            "fax_number": "606-679-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 N HIGHWAY 25 W",
            "address_2": "SUITE 101",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691576",
            "telephone_number": "606-679-2773",
            "fax_number": "606-679-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND FOOT AND ANKLE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-25",
        "last_updated": "2010-08-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "606-679-2773",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90005091",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; 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.