Pinole Podiatry Group Inc

Primary specialty

PodiatristTaxonomy code 213E00000X

License

E4413 Issued in CA

Legal business name

PINOLE PODIATRY GROUP INC

Practice address

2150 Appian Way Ste 206
Pinole, CA 94564-2520

Phone

(510) 724-1530

NPI assigned

Oct 25, 2012

Last updated

May 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael D Grimes, DPMNPI 1275500720

Title

Ceo

Phone

(510) 724-1530

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

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.

• Michael Grimes, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Pinole, CA
  • NPI 1275500720
  Medicare reassignment NPD Authorized official
• Gary J Gadwood, M.D.

  • Surgery Physician
  • Pinole, CA
  • NPI 1730245416
  NPD (past)
• John Hearst Welborn Jr., M.D.

  • Orthopaedic Surgery Physician
  • Pinole, CA
  • NPI 1235179144
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1609129881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 APPIAN WAY STE 206",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642520",
            "telephone_number": "510-724-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 APPIAN WAY STE 206",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642520",
            "telephone_number": "510-724-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINOLE PODIATRY GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-724-1530",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Huyen L Phan
• Pinole Endodontics
• Pinole Hearing Aid Center LLC
• Pinole Operations, LP (Westmont of Pinole)
• Pinole Oral Surgery
• Steve Polonsky
• Angelica Portillo
• Denise Portillo
• Priya Patel Dental Corporation (Pinole Modern Dentistry Dental Group)
• Roger Samuel Proctor, M.D.

• Podiatrist in Pinole, CA
• Providers in Pinole, CA by specialty
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; 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.