NPIMap

Organization Active NPI

Southside Foot Clinic P C

  • Podiatrist
  • Greenwood, IN
National Provider Identifier
1528117553
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
07000316 Issued in IN
Legal business name
SOUTHSIDE FOOT CLINIC P C
Practice address
33 E County Line Rd Ste B
Greenwood, IN 46143-1043
Phone
(317) 882-9303
Fax
(317) 882-6605
NPI assigned
Jan 9, 2007
Last updated
Feb 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

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

Authorized official

Name
Dr. J Karl Winckelbach, DPMNPI 1356302137
Title
Podiatrist
Phone
(317) 882-9303

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X 07000316 IN Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 07000316 IN
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

33 E County Line Rd Ste B
Greenwood, IN 46143-1043

Mailing address

33 E County Line Rd Ste B
Greenwood, IN 46143-1043
Phone (317) 882-9303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080108000149 IN Part B Supplier - Clinic/Group Practice 7113007899 Receives reassigned benefits from 2 practitioners
Practice locations: Greenwood, IN
O20100930047567 IN DME Supplier - Physician - Podiatry 7113007899 Practice locations: Greenwood, IN

National Provider Directory

National Provider Directory

Locations

33 E County Line Rd
Ste B
Greenwood, IN 46143
Phone (317) 690-8901

Practitioners & affiliated clinicians

Practitioners 4

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": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202083200000",
    "number": "1528117553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 E COUNTY LINE RD STE B",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431043",
            "telephone_number": "317-882-9303",
            "fax_number": "317-882-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 E COUNTY LINE RD STE B",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461431043",
            "telephone_number": "317-882-9303",
            "fax_number": "317-882-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FOOT CLINIC P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2008-02-04",
        "status": "A",
        "authorized_official_last_name": "WINCKELBACH",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "317-882-9303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000316",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07000316",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; 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.