NPIMap

Organization Active NPI

Foot and Ankle Center of Issaquah LLC

  • Foot & Ankle Surgery Podiatrist
  • Issaquah, WA
National Provider Identifier
1659758290
Registry record updated Dec 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO60204241 Issued in WA
Legal business name
FOOT AND ANKLE CENTER OF ISSAQUAH LLC
Practice address
22510 SE 64TH PL
Unit 120
Issaquah, WA 98027-5390
Phone
(425) 947-2880
NPI assigned
May 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2015

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

Authorized official

Name
Dr. Stephanie E KimNPI 1093946444
Title
Owner
Phone
(425) 947-2880

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 PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO60204241 WA Primary

Addresses

Primary practice location

22510 SE 64TH PL
Unit 120
Issaquah, WA 98027-5390

Mailing address

6947 Coal Creek Pkwy SE
#753
Newcastle, WA 98059-3136

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151229002780 WA Part B Supplier - Clinic/Group Practice 2264734763 Receives reassigned benefits from 3 practitioners
Practice locations: Issaquah, WA

National Provider Directory

National Provider Directory

Locations

22510 SE 64th Pl
Bldg F
Issaquah, WA 98027

22510 SE 64th Pl
Ste 120
Issaquah, WA 98027
Phone (425) 391-2722

22510 SE 64th Pl
Ste F120
Issaquah, WA 98027

12039 NE 128th St
Ste 103
Kirkland, WA 98034

13125 121st Way NE
Ste E
Kirkland, WA 98034
Phone (425) 899-6030

Practitioners & affiliated clinicians

Practitioners 4

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": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449187200000",
    "number": "1659758290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6947 COAL CREEK PKWY SE",
            "address_2": "#753",
            "city": "NEWCASTLE",
            "state": "WA",
            "postal_code": "980593136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22510 SE 64TH PL",
            "address_2": "UNIT 120",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275390",
            "telephone_number": "425-947-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE CENTER OF ISSAQUAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-12-04",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-947-2880",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO60204241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.