NPIMap

Organization Active NPI

Family Foot & Ankle Clinic PC

  • Podiatrist
  • Decatur, IL
National Provider Identifier
1629127741
Registry record updated Feb 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
060008117 Issued in IL
Legal business name
FAMILY FOOT & ANKLE CLINIC PC
Practice address
1390 N Fairview Ave
Decatur, IL 62526-3618
Phone
(217) 429-1512
Fax
(217) 423-1465
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2011

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

Authorized official

Name
Dr. Stephen Kovach, DPMNPI 1447397468
Title
President
Phone
(217) 429-1512

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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 060008117 IL Primary

Addresses

Primary practice location

1390 N Fairview Ave
Decatur, IL 62526-3618

Mailing address

1390 N Fairview Ave
Decatur, IL 62526-3618
Phone (217) 429-1512

Other identifiers 3

IdentifierTypeStateIssuer
016004985MedicaidIL
CK6281OtherILRAILROAD MEDICARE -
016004984MedicaidIL

National Provider Directory

National Provider Directory

Locations

1770 E Lake Shore Dr
Ste 100
Decatur, IL 62521
Phone (217) 429-1512

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297900800000",
    "number": "1629127741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 N FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263618",
            "telephone_number": "217-429-1512",
            "fax_number": "217-423-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 N FAIRVIEW AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263618",
            "telephone_number": "217-429-1512",
            "fax_number": "217-423-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FOOT & ANKLE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2011-02-17",
        "status": "A",
        "authorized_official_last_name": "KOVACH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-429-1512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "060008117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004985",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE  -",
            "identifier": "CK6281",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004984",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; 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.