Braden Russ Brklacich, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

10861469-0501 Issued in UT

Practice address

12523 S Creek Meadow Rd Ste 105
Riverton, UT 84065-7299

Phone

(801) 253-6886

NPI assigned

Jul 5, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foot and Ankle Specialists of Arizona PLLCGroup PAC ID 7113359555, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner del E. Webb Medical Center Hospital, Sun City West, AZ, CCN 030093

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Foot & Ankle Specialists of Arizona PLLC

  • Foot & Ankle Surgery Podiatrist
  • Glendale, AZ
  • NPI 1316504574
  Medicare reassignment Care Compare group NPD
• Southwest Foot Institute Inc

  • Primary Podiatric Medicine Podiatrist
  • Phoenix, AZ
  • NPI 1871678979
  Medicare reassignment NPD
• Foot & Ankle Specialists of Arizona PLLC

  • Podiatrist
  • Georgetown, TX
  • NPI 1992668222
  NPD
• Southwest Foot Institute Inc

  • Podiatrist
  • Sun City, AZ
  • NPI 1689352692
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Banner del E Webb Medical Center

  • General Acute Care Hospital
  • Sun City West, AZ
  • NPI 1588823553
  Care Compare affiliation

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1609397207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1583 E GREENLEY HILL DR",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840053812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12523 S CREEK MEADOW RD STE 105",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657299",
            "telephone_number": "801-253-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRKLACICH",
        "first_name": "BRADEN",
        "middle_name": "RUSS",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-05",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "10861469-0501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gaylinn Breeze, NP
• Morgan Brenneman
• Brighton House Assisted Living, LLC
• Joshua Brinkerhoff, CPSS
• David Wiltshire Brinton, MD
• Tracy Lynn Broadhead
• Krista Jane Brock, DPT
• Aaron Spencer Brockbank, MD
• Joseph Jacob Bromley, DDS
• Callie Bronson

• Foot & Ankle Surgery Podiatrist in Riverton, UT
• Providers in Riverton, UT by specialty
• Foot & Ankle Surgery Podiatrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.