NPIMap

Organization Active NPI

St. Augustine Foot & Ankle, Inc

  • Specialist
  • St Augustine, FL
National Provider Identifier
1649409756
Registry record updated Sep 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ST. AUGUSTINE FOOT & ANKLE, INC
Practice address
1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300
Phone
(904) 824-0869
Fax
(904) 826-0966
NPI assigned
Jul 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2023

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

Authorized official

Name
Dr. Thomas A Lebeau, D.P.M.NPI 1659587897
Title
Owner
Phone
(904) 824-0869

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300

Mailing address

1 Saint Johns Medical Park Dr
St Augustine, FL 32086-5300
Phone (904) 824-0869

Other identifiers 2

IdentifierTypeStateIssuer
001262300MedicaidFL
6500EOtherFLBLUE CROSS AND BLUE SHIELD OF FLORIDA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091116000569 FL Part B Supplier - Clinic/Group Practice 5294873089 Receives reassigned benefits from 10 practitioners
Practice locations: Saint Augustine, FL
O20100930020855 FL DME Supplier - Physician - Podiatry 5294873089 Practice locations: St Augustine, FL

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Augustine Foot Ankle3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Saint Johns Medical Park Dr
Ste 1
Saint Augustine, FL 32086

Practitioners & affiliated clinicians

Practitioners 10

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": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696032000000",
    "number": "1649409756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT JOHNS MEDICAL PARK DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865300",
            "telephone_number": "904-824-0869",
            "fax_number": "904-826-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT JOHNS MEDICAL PARK DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865300",
            "telephone_number": "904-824-0869",
            "fax_number": "904-826-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AUGUSTINE FOOT & ANKLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2023-09-30",
        "certification_date": "2023-09-30",
        "status": "A",
        "authorized_official_last_name": "LEBEAU",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-824-0869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001262300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF FLORIDA",
            "identifier": "6500E",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2023; 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.