Active NPI
Coast to Coast Foot Doctors
- Podiatrist
- Tarzana, CA
National Provider Identifier
1558064246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- Legal business name
- COAST TO COAST FOOT DOCTORS
- Practice address
- 18740 Ventura Blvd Ste 102
Tarzana, CA 91356-6353 - Phone
- (661) 618-8081
- NPI assigned
- Mar 23, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark R Shelly, MD
- Title
- Owner
- Phone
- (661) 618-8081
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | Primary |
Addresses
Primary practice location
18740 Ventura Blvd Ste 102
Tarzana, CA 91356-6353
Mailing address
18740 Ventura Blvd Ste 102
Tarzana, CA 91356-6353
Phone (818) 708-7668
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230622001659 | CA | Part B Supplier - Clinic/Group Practice | 3072971100 |
Receives reassigned benefits from 7 practitioners Practice locations: Tarzana, CA |
| O20231006002094 | CA | DME Supplier - Physician - Podiatry | 3072971100 | Practice locations: Tarzana, CA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Foot & Ankle Surgery Podiatrist
- Encino, CA
- NPI 1902922149
CA, Foot & Ankle Surgery
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679529600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705622400000",
"number": "1558064246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18740 VENTURA BLVD STE 102",
"city": "TARZANA",
"state": "CA",
"postal_code": "913566353",
"telephone_number": "818-708-7668",
"fax_number": "818-708-9668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18740 VENTURA BLVD STE 102",
"city": "TARZANA",
"state": "CA",
"postal_code": "913566353",
"telephone_number": "661-618-8081"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COAST TO COAST FOOT DOCTORS",
"organizational_subpart": "NO",
"enumeration_date": "2023-03-23",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A",
"authorized_official_last_name": "SHELLY",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "661-618-8081",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tarzana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.