NPIMap

Organization Active NPI

Fairbanks Foot & Ankle Inc.

  • Podiatrist
  • Fairbanks, AK
National Provider Identifier
1659687945
Registry record updated Aug 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2810 Issued in AK
Legal business name
FAIRBANKS FOOT & ANKLE INC.
Practice address
1405 Kellum St.
Ste 200
Fairbanks, AK 99701
Phone
(907) 451-9202
Fax
(907) 452-6256
NPI assigned
Aug 24, 2010
Last updated
Aug 24, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2010

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

Authorized official

Name
Dr. Ralph Sylvan Dixon, DPMNPI 1558498402
Title
Owner/President
Phone
(907) 451-9202

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 2810 AK Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 2810 AK

Addresses

Primary practice location

1405 Kellum St.
Ste 200
Fairbanks, AK 99701

Mailing address

1405 Kellum St.
Ste 200
Fairbanks, AK 99701
Phone (907) 451-9202

Other identifiers 1

IdentifierTypeStateIssuer
PD2810MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100811000834 AK Part B Supplier - Clinic/Group Practice 8224162359 Receives reassigned benefits from 2 practitioners
Practice locations: Fairbanks, AK

National Provider Directory

National Provider Directory

Locations

1405 Kellum St
Ste 200
Fairbanks, AK 99701
Phone (907) 451-9202

Practitioners & affiliated clinicians

Practitioners 3

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": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282608000000",
    "number": "1659687945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST.",
            "address_2": "STE 200",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-451-9202",
            "fax_number": "907-452-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 KELLUM ST.",
            "address_2": "STE 200",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-451-9202",
            "fax_number": "907-452-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS FOOT & ANKLE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2010-08-24",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "SYLVAN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "907-451-9202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AK",
            "license": "2810",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AK",
            "license": "2810",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PD2810",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; 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.