NPIMap

Organization Active NPI

Elgin Foot & Ankle Center, S.C.

  • Foot & Ankle Surgery Podiatrist
  • Elgin, IL
National Provider Identifier
1639270663
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
ELGIN FOOT & ANKLE CENTER, S.C.
Practice address
750 Fletcher Dr Ste 300
Elgin, IL 60123
Phone
(847) 741-3127
Fax
(847) 741-3173
NPI assigned
Sep 25, 2006
Last updated
Jul 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Authorized official

Name
Dr. Kenneth E Jacoby, DPMNPI 1821199910
Title
President
Phone
(847) 741-3127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X Primary

Addresses

Primary practice location

750 Fletcher Dr Ste 300
Elgin, IL 60123

Mailing address

750 Fletcher Dr Ste 300
Elgin, IL 60123-4703
Phone (847) 741-3127

Other practice location 1

396 Remington Blvd Ste 370
Bolingbrook, IL 60440
Phone (630) 418-6601

Other identifiers 1

IdentifierTypeStateIssuer
DD0562OtherILRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050425000593 IL Part B Supplier - Clinic/Group Practice 6002854569 Receives reassigned benefits from 7 practitioners
Practice locations: Saint Charles, IL; Elgin, IL; Hoffman Estates, IL
O20100930096769 IL DME Supplier - Physician - Podiatry 6002854569 Practice locations: Elgin, IL

National Provider Directory

National Provider Directory

Locations

396 Remington Blvd
Ste 370
Bolingbrook, IL 60440
Phone (630) 418-6601

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1639270663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 FLETCHER DR STE 300",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601234703",
            "telephone_number": "847-741-3127",
            "fax_number": "847-741-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FLETCHER DR STE 300",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "60123",
            "telephone_number": "847-741-3127",
            "fax_number": "847-741-3173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "396 Remington Blvd Ste 370",
            "address_purpose": "LOCATION",
            "city": "Bolingbrook",
            "state": "IL",
            "postal_code": "60440",
            "country_code": "US",
            "telephone_number": "630-418-6601",
            "fax_number": "630-312-2223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELGIN FOOT & ANKLE CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-741-3127",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD0562",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.