NPIMap

Organization Active NPI

Wellness Podiatry Corp

Doing business as Wellness Podiatry

  • Foot & Ankle Surgery Podiatrist
  • Roseville, CA
National Provider Identifier
1598526204
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
WELLNESS PODIATRY CORP
Doing business as
Wellness Podiatry
Practice address
1650 Lead Hill Blvd Ste 100
Roseville, CA 95661-3072
Phone
(916) 786-3434
Fax
(916) 786-6770
NPI assigned
Jan 19, 2024
Last updated
Jan 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLNESS PODIATRY CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Authorized official

Name
Dr. Benjamin Van PhamNPI 1194884387
Title
Owner
Phone
(916) 786-3434

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 NU Primary

Addresses

Primary practice location

1650 Lead Hill Blvd Ste 100
Roseville, CA 95661-3072

Mailing address

685 Twelve Bridges Dr Ste F
Lincoln, CA 95648-8689
Phone (916) 786-3434

Other names 1

  • Wellness Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230726004024 CA Part B Supplier - Clinic/Group Practice 4688035439 Receives reassigned benefits from 3 practitioners
4 other NPIs on this enrollment
Practice locations: Auburn, CA; Lincoln, CA; Roseville, CA; Sacramento, CA
O20240219002026 CA DME Supplier - Physician - Podiatry 4688035439 Practice locations: Roseville, CA

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Wellness Podiatry Corp5 organizations share this tax ID, including this one
Part of
Wellness Podiatry Corp

Other organizations with this tax ID 4

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

Locations

841 Sterling Pkwy
Ste 130
Lincoln, CA 95648
Phone (916) 434-6410

5025 J St
Ste 316
Sacramento, CA 95819
Phone (916) 732-2277

Practitioners & affiliated clinicians

Practitioners 3

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": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705622400000",
    "number": "1598526204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 TWELVE BRIDGES DR STE F",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956488689",
            "telephone_number": "916-786-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 LEAD HILL BLVD STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613072",
            "telephone_number": "916-786-3434",
            "fax_number": "916-786-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS PODIATRY CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLNESS PODIATRY CORP",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-786-3434",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, 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.

Verify at the official NPI Registry.