NPIMap

Organization Active NPI

University Foot and Ankle Institute a Podiatric Surgical Center

  • Foot & Ankle Surgery Podiatrist
  • San Pedro, CA
National Provider Identifier
1497598346
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTER
Practice address
1360 W 6TH St Ste 240
San Pedro, CA 90732-3589
Phone
(310) 548-3311
Fax
(310) 791-3311
NPI assigned
Jun 18, 2024
Organization subpart
Yes
Parent organization
UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Alexander Reyzelman, DPM
Title
Crmo
Phone
(415) 292-0638

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1360 W 6TH St Ste 240
San Pedro, CA 90732-3589

Mailing address

1660 Feehanville Dr Ste 450
Mount Prospect, IL 60056-6023
Phone (847) 627-4920

Other names 1

  • University Foot & Ankle Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240712000322 CA DME Supplier - Physician - Podiatry 3971493347 Practice locations: San Pedro, CA

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
University Foot and Ankle Institute12 organizations share this tax ID, including this one
Part of
University Foot and Ankle Institute

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1497598346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 FEEHANVILLE DR STE 450",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600566023",
            "telephone_number": "847-627-4920",
            "fax_number": "224-220-9743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 W 6TH ST STE 240",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323589",
            "telephone_number": "310-548-3311",
            "fax_number": "310-791-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTER",
        "enumeration_date": "2024-06-18",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "REYZELMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CRMO",
        "authorized_official_telephone_number": "415-292-0638",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Foot & Ankle Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.