NPIMap

Organization Active NPI

Shoal Creek Foot and Ankle Center LLC

  • Foot & Ankle Surgery Podiatrist
  • Springfield, MO
National Provider Identifier
1538884697
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
SHOAL CREEK FOOT AND ANKLE CENTER LLC
Practice address
4136 S McCann CT
Springfield, MO 65804-7253
Phone
(417) 755-7612
NPI assigned
Oct 11, 2022
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Shelly Diane Sedberry, DPMNPI 1770978074
Title
Physician/Owner
Phone
(417) 622-0648

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

4136 S McCann CT
Springfield, MO 65804-7253

Mailing address

1801 W 32ND St Ste 102
Joplin, MO 64804-1528
Phone (417) 622-0648

National Provider Directory

National Provider Directory
Tax ID family
Shoal Creek Foot and Ankle Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

4136 S McCann Ct
Springfield, MO 65804
Phone (417) 755-7612

Practitioners & affiliated clinicians

Practitioners 8

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": "1665446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1538884697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W 32ND ST STE 102",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041528",
            "telephone_number": "417-622-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4136 S MCCANN CT",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047253",
            "telephone_number": "417-755-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOAL CREEK FOOT AND ANKLE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-11",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "SEDBERRY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "417-622-0648",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.