NPIMap

Organization Active NPI

Eastern Podiatry LLC

Doing business as Eastern Podiatry

  • Foot & Ankle Surgery Podiatrist
  • Las Vegas, NV
National Provider Identifier
1568509016
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0040 Issued in NV
Legal business name
EASTERN PODIATRY LLC
Doing business as
Eastern Podiatry
Practice address
3777 S. Pecos McLeod
Suite 103
Las Vegas, NV 89121-4265
Phone
(702) 434-2023
Fax
(702) 434-1976
NPI assigned
Jan 31, 2007
Last updated
Nov 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Authorized official

Name
Jeremy W. Wood, D.P.M.NPI 1831159128
Title
President
Phone
(702) 434-2023

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 0040 NV Primary

Addresses

Primary practice location

3777 S. Pecos McLeod
Suite 103
Las Vegas, NV 89121-4265

Mailing address

3777 S. Pecos McLeod
Suite 103
Las Vegas, NV 89121-4265
Phone (702) 434-2023

Other identifiers 1

IdentifierTypeStateIssuer
C03159OtherNVMRR

Other names 1

  • Eastern Podiatry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040528000574 NV Part B Supplier - Clinic/Group Practice 2961483557 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3777 Pecos McLeod
Ste 103
Las Vegas, NV 89121
Phone (702) 324-2713

Practitioners & affiliated clinicians

Practitioners 7

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1568509016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 S. PECOS MCLEOD",
            "address_2": "SUITE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891214265",
            "telephone_number": "702-434-2023",
            "fax_number": "702-434-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 S. PECOS MCLEOD",
            "address_2": "SUITE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891214265",
            "telephone_number": "702-434-2023",
            "fax_number": "702-434-1976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-434-2023",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NV",
            "license": "0040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MRR",
            "identifier": "C03159",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.