NPIMap

Individual provider Active NPI

Jesse Fischer, C. PED, BOCPD

  • Pedorthist
  • Saint Louis, MO
National Provider Identifier
1689085706
Registry record updated May 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PedorthistTaxonomy code 224L00000X
License
CPED4080 Issued in DE
Practice address
11693 Manchester Rd
Saint Louis, MO 63131-4613
Phone
(314) 822-3300
Fax
(314) 822-1082
NPI assigned
May 12, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pedorthist 224L00000X CPED4080 DE Primary
Pedorthist 224L00000X C51558 MD

Addresses

Primary practice location

11693 Manchester Rd
Saint Louis, MO 63131-4613

Mailing address

11693 Manchester Rd
Saint Louis, MO 63131-4613
Phone (314) 822-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CPED4080DEMDPedorthist
C51558MDMDPedorthist

Practice roles

OrganizationSpecialtyStatusNew patients
Comfort Shoe Specialists Past Accepting new patients
Comfort Shoe Specialists Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399852800000",
    "number": "1689085706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11693 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631314613",
            "telephone_number": "314-822-3300",
            "fax_number": "314-822-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11693 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631314613",
            "telephone_number": "314-822-3300",
            "fax_number": "314-822-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISCHER",
        "first_name": "JESSE",
        "name_prefix": "Mr.",
        "credential": "C. PED, BOCPD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-12",
        "last_updated": "2014-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "DE",
            "license": "CPED4080",
            "primary": true
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "MD",
            "license": "C51558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.