Organization Active NPI

Claremore Podiatry, P.C.

  • Podiatrist
  • Claremore, OK
National Provider Identifier
1679594733
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
CLAREMORE PODIATRY, P.C.
Practice address
1218 N Florence Ave
Claremore, OK 74017-3109
Phone
(918) 341-6821
Fax
(918) 342-8128
NPI assigned
Jul 22, 2006
Last updated
Apr 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Authorized official

Name
Mary Johnson, D.P.M.
Title
Owner/Physician
Phone
(918) 341-6821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

1218 N Florence Ave
Claremore, OK 74017-3109

Mailing address

1218 N Florence Ave
Claremore, OK 74017-3109
Phone (918) 341-6821

Other identifiers 1

IdentifierTypeStateIssuer
200051750AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050329000522 OK Part B Supplier - Clinic/Group Practice 9335199850 Receives reassigned benefits from 2 practitioners
Practice locations: Claremore, OK
O20100930031393 OK DME Supplier - Physician - Podiatry 9335199850 Practice locations: Claremore, OK

National Provider Directory

National Provider Directory

Locations

1218 N Florence Ave
Ste D
Claremore, OK 74017
Phone (918) 341-6821

Practitioners & affiliated clinicians

Practitioners 2

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": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1679594733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 N FLORENCE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740173109",
            "telephone_number": "918-341-6821",
            "fax_number": "918-342-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 N FLORENCE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740173109",
            "telephone_number": "918-341-6821",
            "fax_number": "918-342-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAREMORE PODIATRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "918-341-6821",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200051750A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.