Crystal Lake Foot & Ankle Center LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

CRYSTAL LAKE FOOT & ANKLE CENTER LLC

Practice address

39 S Virginia St
Crystal Lake, IL 60014-5826

Phone

(815) 477-9221

NPI assigned

Jan 23, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Paul Potach, D.P.M.NPI 1073627410

Title

Owner

Phone

(815) 477-9221

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 2

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

• Paul Potach, DPM

  • Podiatrist
  • Wheeling, IL
  • NPI 1073627410
  Medicare reassignment Care Compare group NPD Authorized official
• Jeffrey Blank

  • Foot & Ankle Surgery Podiatrist
  • Wheeling, IL
  • NPI 1235142605
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1649986795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145826",
            "telephone_number": "815-477-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 S VIRGINIA ST",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145826",
            "telephone_number": "815-477-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE FOOT & ANKLE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "POTACH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-477-9221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Lake Center for Chronic Pain SC
• Crystal Lake Dermatology SC
• Crystal Lake Family Dental
• Crystal Lake Family Treatment Center LTD
• Crystal Lake Family Wellness
• Crystal Lake Immediate Care Physicians LTD.
• Crystal Lake Medical and Sports Rehab SC
• Crystal Lake Memory Care, LLC
• Crystal Lake Natural Health Care
• Crystal Lake Ophthalmology Associates PC

• Foot & Ankle Surgery Podiatrist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

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