NPIMap

Organization Active NPI

PNC Podiatry of Washington PLLC

Doing business as Integrative Foot and Ankle Centers of Washington

  • Foot & Ankle Surgery Podiatrist
  • Everett, WA
National Provider Identifier
1568209153
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PNC PODIATRY OF WASHINGTON PLLC
Doing business as
Integrative Foot and Ankle Centers of Washington
Practice address
1823 37TH St Ste a
Everett, WA 98201-5089
Phone
(425) 822-7426
Fax
(425) 827-1717
NPI assigned
Jul 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Jessica Boyd
Title
Credentialing Manager
Phone
(847) 627-4920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1823 37TH St Ste a
Everett, WA 98201-5089

Mailing address

13030 121St Way NE Ste 204
Kirkland, WA 98034-3008
Phone (425) 822-7426

Other names 1

  • INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240830000850 WA DME Supplier - Physician - Podiatry 3971950312 Practice locations: Everett, WA

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
PNC Podiatry of Washington6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1720569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1568209153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13030 121ST WAY NE STE 204",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343008",
            "telephone_number": "425-822-7426",
            "fax_number": "425-827-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 37TH ST STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982015089",
            "telephone_number": "425-822-7426",
            "fax_number": "425-827-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNC PODIATRY OF WASHINGTON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "847-627-4920"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRATIVE FOOT AND ANKLE CENTERS OF WASHINGTON",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.