John W. Scivally, D.P.M Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

E4319 Issued in CA

Legal business name

JOHN W. SCIVALLY, D.P.M INC

Practice address

2227 Olympic Blvd
Walnut Creek, CA 94595-1623

Phone

(925) 937-2860

Fax

(925) 937-5565

NPI assigned

Jan 11, 2008

Organization subpart

No

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

Authorized official

Name

Mr. John W Scivally, D.P.MNPI 1518951722

Title

Owner/ Physician

Phone

(925) 937-2860

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bay Area Foot and Ankle Associates Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• John W Scivally, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Walnut Creek, CA
  • NPI 1518951722

  CA, Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD Authorized official
• Robin K Lie, DPM

  • Podiatrist
  • Walnut Creek, CA
  • NPI 1689785131

  CA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1639355381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 OLYMPIC BLVD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945951623",
            "telephone_number": "925-937-2860",
            "fax_number": "925-937-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 OLYMPIC BLVD",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945951623",
            "telephone_number": "925-937-2860",
            "fax_number": "925-937-5565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 Balfour Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "CA",
            "postal_code": "945134957",
            "country_code": "US",
            "telephone_number": "925-937-2860 x1",
            "fax_number": "925-937-5565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JOHN W. SCIVALLY, D.P.M INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "SCIVALLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/ PHYSICIAN",
        "authorized_official_telephone_number": "925-937-2860",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.P.M"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E43190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Area Foot and Ankle Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Walnut Creek, CA
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.