Active NPI
Philip A. Maynard, D.P.M.
- Foot Surgery Podiatrist
- Hastings, NE
National Provider Identifier
1619970381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- 159
- Practice address
- 416 N Minnesota Ave
Hastings, NE 68901-5254 - Phone
- (402) 462-2788
- Fax
- (402) 462-4783
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | 159 | NE | Primary |
| Podiatrist | 213E00000X | 159 | NE | |
| Foot Surgery Podiatrist | 213ES0131X | 00365 | IA | |
| Podiatrist | 213E00000X | 00365 | IA |
Addresses
Primary practice location
416 N Minnesota Ave
Hastings, NE 68901-5254
Mailing address
416 N Minnesota Ave
Hastings, NE 68901-5254
Phone (402) 462-2788
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02513 | Other | NE | BC-BS OF NE |
| 480021803 | Other | NE | RAILROAD MEDICARE |
| 1197710001 | Other | NE | DME NORIDAN |
| 47062581300 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00365 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1619970381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 N MINNESOTA AVE",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689015254",
"telephone_number": "402-462-2788",
"fax_number": "402-462-4783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "416 N MINNESOTA AVE",
"city": "HASTINGS",
"state": "NE",
"postal_code": "689015254",
"telephone_number": "402-462-2788",
"fax_number": "402-462-4783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYNARD",
"first_name": "PHILIP",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "NE",
"license": "159",
"primary": true
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NE",
"license": "159",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "IA",
"license": "00365",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IA",
"license": "00365",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC-BS OF NE",
"identifier": "02513",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480021803",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME NORIDAN",
"identifier": "1197710001",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47062581300",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hastings, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.