Active NPI
Robert Wayne, B.O.C.O
- Orthotist
- Waddell, AZ
National Provider Identifier
1477050615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- C15463
- Practice address
- 18140 W Purdue Ave
Waddell, AZ 85355-4237 - Phone
- (602) 320-4521
- NPI assigned
- Apr 12, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | C15463 | AZ | Primary |
Addresses
Primary practice location
18140 W Purdue Ave
Waddell, AZ 85355-4237
Mailing address
18140 W Purdue Ave
Waddell, AZ 85355-4237
Phone (602) 320-4521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C15463 | AZ | MD | Orthotist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1477050615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18140 W PURDUE AVE",
"city": "WADDELL",
"state": "AZ",
"postal_code": "853554237",
"telephone_number": "602-320-4521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18140 W PURDUE AVE",
"city": "WADDELL",
"state": "AZ",
"postal_code": "853554237",
"telephone_number": "602-320-4521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAYNE",
"first_name": "ROBERT",
"credential": "B.O.C.O",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-12",
"last_updated": "2020-10-22",
"certification_date": "2020-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "AZ",
"license": "C15463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waddell, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.