NPIMap

Organization Active NPI

Foot and Ankle Clinic, PC

  • Foot & Ankle Surgery Podiatrist
  • Sioux City, IA
National Provider Identifier
1649387424
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
00505 Issued in IA
Legal business name
FOOT AND ANKLE CLINIC, PC
Practice address
1502 Pierce St
Sioux City, IA 51105-1246
Phone
(712) 255-0502
Fax
(712) 258-9977
NPI assigned
Aug 25, 2006
Last updated
Jan 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Authorized official

Name
Dr. Kham Vay Ung, DPMNPI 1205937554
Title
President/Owner
Phone
(712) 255-0502

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
Foot & Ankle Surgery Podiatrist 213ES0103X 00505 IA Primary

Addresses

Primary practice location

1502 Pierce St
Sioux City, IA 51105-1246

Mailing address

1502 Pierce St
Sioux City, IA 51105-1246
Phone (712) 255-0502

Other identifiers 4

IdentifierTypeStateIssuer
6800454MedicaidSD
0476317MedicaidIA
6800690MedicaidSD
6800700MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, SD, MN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040326001326 IA Part B Supplier - Clinic/Group Practice 2567354269 Receives reassigned benefits from 2 practitioners
Practice locations: Sioux City, IA
O20040422000405 SD Part B Supplier - Clinic/Group Practice 2567354269 Receives reassigned benefits from 2 practitioners
Practice locations: Brookings, SD; Dakota Dunes, SD; Viborg, SD
O20100427000833 MN Part B Supplier - Clinic/Group Practice 2567354269 Receives reassigned benefits from 1 practitioner
Practice locations: Detroit Lakes, MN
O20100930041195 IA DME Supplier - Physician - Podiatry 2567354269 Practice locations: Sioux City, IA

National Provider Directory

National Provider Directory

Locations

2720 Pierce St
St Lukes Regional Medical Ctr
Sioux City, IA 51104
Phone (712) 279-3500

Practitioners & affiliated clinicians

Practitioners 9

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1649387424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 PIERCE ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051246",
            "telephone_number": "712-255-0502",
            "fax_number": "712-258-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 PIERCE ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051246",
            "telephone_number": "712-255-0502",
            "fax_number": "712-258-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "UNG",
        "authorized_official_first_name": "KHAM",
        "authorized_official_middle_name": "VAY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "712-255-0502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IA",
            "license": "00505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800454",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0476317",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800690",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6800700",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.