NPIMap

Organization Active NPI

Geriatric Podiatry Medical Group Inc.

  • Public Medicine Podiatrist
  • San Dimas, CA
National Provider Identifier
1598832172
Registry record updated Dec 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Medicine PodiatristTaxonomy code 213EP0504X
Legal business name
GERIATRIC PODIATRY MEDICAL GROUP INC.
Practice address
425 W Bonita Ave Ste 110
San Dimas, CA 91773-2543
Phone
(909) 599-0981
Fax
(909) 592-0738
NPI assigned
Nov 29, 2006
Last updated
Dec 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2014

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

Authorized official

Name
William H Tabb, DPMNPI 1942307764
Title
Owner
Phone
(909) 599-0981

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP0504X Primary

Addresses

Primary practice location

425 W Bonita Ave Ste 110
San Dimas, CA 91773-2543

Mailing address

425 W Bonita Ave Ste 110
San Dimas, CA 91773-2543
Phone (909) 599-0981

Other identifiers 3

IdentifierTypeStateIssuer
GRE000050MedicaidCA
CJ3207OtherCAPALMETTO GBA
GRE000052MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1598832172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE STE 110",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732543",
            "telephone_number": "909-599-0981",
            "fax_number": "909-592-0738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE STE 110",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732543",
            "telephone_number": "909-599-0981",
            "fax_number": "909-592-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC PODIATRY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "TABB",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-599-0981",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP0504X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE000050",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "CJ3207",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE000052",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.