Active NPI
Alwin Max Juchheim III, DPM
- Podiatrist
- Grenada, MS
National Provider Identifier
1689666539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 80068
- Practice address
- 1300 Sunset Dr
Suite P
Grenada, MS 38901-4086 - Phone
- (662) 226-3333
- Fax
- (662) 226-7722
- NPI assigned
- Aug 17, 2005
- Last updated
- Mar 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 80068 | MS | Primary |
Addresses
Primary practice location
1300 Sunset Dr
Suite P
Grenada, MS 38901-4086
Mailing address
1300 Sunset Dr
Suite P
Grenada, MS 38901-4086
Phone (662) 226-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00011116 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111207000264 | MS | Practitioner - Podiatry | 9931151859 | Practice locations: Oxford, MS |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80068 | MS | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205971200000",
"number": "1689666539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 SUNSET DR",
"address_2": "SUITE P",
"city": "GRENADA",
"state": "MS",
"postal_code": "389014086",
"telephone_number": "662-226-3333",
"fax_number": "662-226-7722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 SUNSET DR",
"address_2": "SUITE P",
"city": "GRENADA",
"state": "MS",
"postal_code": "389014086",
"telephone_number": "662-226-3333",
"fax_number": "662-226-7722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUCHHEIM",
"first_name": "ALWIN",
"middle_name": "MAX",
"name_suffix": "III",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-17",
"last_updated": "2008-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "MS",
"license": "80068",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00011116",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grenada, MS
- Nekesha Micole Johnson, FNP-BC
- Luanne Fair Pender Jones, PHARM. D.
- Charles Raymond Jordan, FNP
- Joseph F Roberts MD PA
- Joseph S Messina Jr MD (Internal Medicine Clinic Of Grenada)
- JWM Therapy Services (JWM Pediatric Therapy)
- K Squared, Inc. (Kringle Dentistry)
- Karen Plunkett, M.D.PC
- Kasp Consulting Inc
- Lewis Wesley Keen Jr., MSN CRNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.