White Bear Foot and Ankle Clinic Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

WHITE BEAR FOOT AND ANKLE CLINIC INC

Practice address

4653 White Bear Pkwy
White Bear Lake, MN 55110-3300

Phone

(651) 426-3995

Fax

(651) 426-5626

NPI assigned

Mar 26, 2014

Organization subpart

No

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

Authorized official

Name

Christopher M Phillips, DPMNPI 1891081386

Title

Owner

Phone

(651) 426-3995

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Tax ID family

White Bear Foot and Ankle Clinic Inc2 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.

• White Bear Foot and Ankle Clinic, Inc.

  • Podiatric Clinic/Center
  • White Bear Lake, MN
  • NPI 1659777290
  NPD tax ID

Locations

Practitioners 7

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

• Christopher M Phillips, DPM.

  • Foot & Ankle Surgery Podiatrist
  • White Bear Lake, MN
  • NPI 1891081386
  Medicare reassignment Care Compare group NPD Authorized official
• Ross Nelson, DPM

  • Foot Surgery Podiatrist
  • Saint Paul, MN
  • NPI 1740285220
  Medicare reassignment Care Compare group NPD
• Corey Edward Valentine, D.P.M.

  • Foot Surgery Podiatrist
  • Mora, MN
  • NPI 1952612418
  Medicare reassignment Care Compare group NPD
• Melanie Johnson, D.P.M.

  • Foot Surgery Podiatrist
  • White Bear Lake, MN
  • NPI 1053639732
  Medicare reassignment Care Compare group
• Margaret Kedzie, DPM

  • Foot & Ankle Surgery Podiatrist
  • Maplewood, MN
  • NPI 1437681947
  Medicare reassignment Care Compare group
• Veasna Thel Srey, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Fort Carson, CO
  • NPI 1669452314

  MN

  Medicare reassignment Care Compare group
• Christopher James Kedzie, DPM

  • Podiatrist
  • Maplewood, MN
  • NPI 1699396176
  Medicare reassignment

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1467879684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4653 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-426-3995",
            "fax_number": "651-426-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4653 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-426-3995",
            "fax_number": "651-426-5626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE BEAR FOOT AND ANKLE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-426-3995",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "472603200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaya Werner, LADC
• Megan Westerheide, LICSW
• Lea Wetzell, L.N, C.N.S
• White Bear Area Senior Progam Isd 624
• White Bear Dentists, PC
• White Bear Foot and Ankle Clinic, Inc.
• White Bear Foot Clinic Inc
• White Bear Health Mart Pharmacy LLC
• White Bear Lake Orthodontics
• White Bear Smiles, P.a.

• Foot & Ankle Surgery Podiatrist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Foot & Ankle Surgery Podiatrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; 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.