Tidewater Foot & Ankle Associates, Inc.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO3663 Issued in FL

Legal business name

TIDEWATER FOOT & ANKLE ASSOCIATES, INC.

Practice address

4168 Woodlands Pkwy Ste B
Palm Harbor, FL 34685-3496

Phone

(813) 925-9431

NPI assigned

Mar 27, 2018

Last updated

Jun 10, 2024By 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

Dr. Megan Johnson, DPMNPI 1114211299

Title

Owner/ Physician

Phone

(813) 925-9431

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Tidewater Foot & Ankle Associates, Inc.

  • Podiatrist
  • Palm Harbor, FL
  • NPI 1033837992

  1850646779

  Same PAC ID

Practitioners 2

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.

• Megan Brook Johnson, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Palm Harbor, FL
  • NPI 1114211299
  Medicare reassignment Care Compare group NPD Authorized official
• Kyle Johnson, DPM

  • Foot & Ankle Surgery Podiatrist
  • Palm Harbor, FL
  • NPI 1275824419
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1629573217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4168 WOODLANDS PKWY STE B",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346853496",
            "telephone_number": "813-925-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4168 WOODLANDS PKWY STE B",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346853496",
            "telephone_number": "813-925-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER FOOT & ANKLE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-27",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "OWNER/ PHYSICIAN",
        "authorized_official_telephone_number": "813-925-9431",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "7720870001",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Nicole Thornburg
• Nicole Thornton, OTR
• Three Rooker Therapy
• Jaime Allison Tickett, BS
• Tidewater Foot & Ankle Associates, Inc.
• Tina Marie Tiernan, OTRL
• Douglas F Tight, PA
• Harriet Delores Tillman
• Timothy C. Runyon, DPM, PA (Certified Foot & Ankle Specialists)
• Timothy T. McLaughlin, M.D., P.a.

• Foot & Ankle Surgery Podiatrist in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.