NPIMap

Organization Active NPI

Healthdrive Podiatry Group, PC

  • Podiatrist
  • Columbia, MD
National Provider Identifier
1548685258
Registry record updated Nov 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
HEALTHDRIVE PODIATRY GROUP, PC
Practice address
6700 Alexander Bell Dr
Suite 200
Columbia, MD 21046-2122
Phone
(888) 964-6681
Fax
(888) 662-0859
NPI assigned
Mar 4, 2014
Last updated
Nov 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2020

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

Authorized official

Name
Dr. Shadi Adib Abboud, DPMNPI 1083704860
Title
Treasurer/Practice Director
Phone
(857) 255-0486

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

6700 Alexander Bell Dr
Suite 200
Columbia, MD 21046-2122

Mailing address

100 Crossing Blvd
Suite 300
Framingham, MA 01702-5555
Phone (617) 964-6681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20140805001308 MD Part B Supplier - Clinic/Group Practice 3375446958 Receives reassigned benefits from 10 practitioners
Practice locations: Columbia, MD
O20160412000208 DC Part B Supplier - Clinic/Group Practice 3375446958 Receives reassigned benefits from 18 practitioners
Practice locations: Alexandria, VA; Takoma Park, MD
O20201105000851 VA Part B Supplier - Clinic/Group Practice 3375446958 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Hampton, VA

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Diadra M Wright DPM10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Morristown ManorMorristown, IN, CCN 155691 Skilled nursing facility Adp of the SNF Mar 7, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604188800000",
    "number": "1548685258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROSSING BLVD",
            "address_2": "SUITE 300",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017025555",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 ALEXANDER BELL DR",
            "address_2": "SUITE 200",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210462122",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHDRIVE PODIATRY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2020-11-01",
        "certification_date": "2020-11-01",
        "status": "A",
        "authorized_official_last_name": "ABBOUD",
        "authorized_official_first_name": "SHADI",
        "authorized_official_middle_name": "ADIB",
        "authorized_official_title_or_position": "TREASURER/PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "857-255-0486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.