NPIMap

Organization Active NPI

San Juan Foot and Ankle Center

  • Foot & Ankle Surgery Podiatrist
  • Montrose, CO
National Provider Identifier
1578622502
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
628 Issued in CO
Legal business name
SAN JUAN FOOT AND ANKLE CENTER
Practice address
1825 E Main St Ste a
Montrose, CO 81401-3848
Phone
(970) 240-3338
Fax
(970) 240-1541
NPI assigned
Dec 6, 2006
Last updated
Oct 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Authorized official

Name
Mr. Christopher O Cook, DPMNPI 1336193697
Title
President
Phone
(970) 240-3338

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 PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 628 CO Primary

Addresses

Primary practice location

1825 E Main St Ste a
Montrose, CO 81401-3848

Mailing address

PO Box 21150
Boulder, CO 80308-4150
Phone (970) 240-3338

Other identifiers 1

IdentifierTypeStateIssuer
94132526MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061212000326 CO Part B Supplier - Clinic/Group Practice 3971502329 Receives reassigned benefits from 2 practitioners
Practice locations: Delta, CO; Montrose, CO
O20100930042869 CO DME Supplier - Physician - Podiatry 3971502329 1 other NPI on this enrollment
Practice locations: Montrose, CO

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
San Juan Foot Ankle Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1825 E Main St
Montrose, CO 81401

1825 E Main St
Ste A
Montrose, CO 81401
Phone (970) 240-3338

Practitioners & affiliated clinicians

Practitioners 2

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": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1578622502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21150",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803084150",
            "telephone_number": "970-240-3338",
            "fax_number": "970-240-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 E MAIN ST STE A",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814013848",
            "telephone_number": "970-240-3338",
            "fax_number": "970-240-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN FOOT AND ANKLE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-240-3338",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CO",
            "license": "628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94132526",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montrose, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.