NPIMap

Organization Active NPI

Healthdrive Podiatry Group, PC

Doing business as HealthDrive Podiatry Group

  • Podiatrist
  • Brookfield, WI
National Provider Identifier
1679504427
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
HEALTHDRIVE PODIATRY GROUP, PC
Doing business as
HealthDrive Podiatry Group
Practice address
200 S Executive Dr
Suite 101
Brookfield, WI 53005-4216
Phone
(414) 535-8134
Fax
(414) 535-8135
NPI assigned
Jul 6, 2006
Last updated
Apr 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

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

Authorized official

Name
Dr. Shadi Adib Abboud, DPMNPI 1083704860
Title
Treasurer/Practice Director
Phone
(857) 255-0486

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X Primary

Addresses

Primary practice location

200 S Executive Dr
Suite 101
Brookfield, WI 53005-4216

Mailing address

100 Crossing Blvd
Suite 300
Framingham, MA 01702-5555
Phone (617) 964-6681

Other identifiers 2

IdentifierTypeStateIssuer
43264300MedicaidWI
CD2116OtherWIMEDICARE RAILROAD

Other names 1

  • HealthDrive Podiatry Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040928000155 WI Part B Supplier - Clinic/Group Practice 3375446958 Receives reassigned benefits from 15 practitioners
Practice locations: Brookfield, WI

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Giang Nguyen DPM10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

25 Needham St
#2116
Newton, MA 02461

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Morristown ManorMorristown, IN, CCN 155691 Skilled nursing facility Adp of the SNF Mar 7, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586995200000",
    "number": "1679504427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROSSING BLVD",
            "address_2": "SUITE 300",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017025555",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S EXECUTIVE DR",
            "address_2": "SUITE 101",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054216",
            "telephone_number": "414-535-8134",
            "fax_number": "414-535-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHDRIVE PODIATRY GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A",
        "authorized_official_last_name": "ABBOUD",
        "authorized_official_first_name": "SHADI",
        "authorized_official_middle_name": "ADIB",
        "authorized_official_title_or_position": "TREASURER/PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "857-255-0486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43264300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CD2116",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthDrive Podiatry Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthDrive Podiatry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.