Active NPI
David Ira Metzendorf, DPM
- Podiatrist
- Winter Haven, FL
National Provider Identifier
1689680621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- PO0001385
- Practice address
- 135 1St St South
Winter Haven, FL 33880 - Phone
- (863) 293-1968
- Fax
- (863) 293-7961
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 | PO0001385 | FL | Primary |
Addresses
Primary practice location
135 1St St South
Winter Haven, FL 33880
Mailing address
135 1St St South
Winter Haven, FL 33880
Phone (863) 293-1968
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029684800 | Medicaid | FL | |
| 593258147 | Other | FL | TAX ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO0001385 | FL | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Podiatry Center PA | Podiatrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Podiatrist
- Winter Haven, FL
- NPI 1477661395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293062400000",
"number": "1689680621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 1ST ST SOUTH",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "33880",
"telephone_number": "863-293-1968",
"fax_number": "863-293-7961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 1ST ST SOUTH",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "33880",
"telephone_number": "863-293-1968",
"fax_number": "863-293-7961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "METZENDORF",
"first_name": "DAVID",
"middle_name": "IRA",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2010-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "FL",
"license": "PO0001385",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "029684800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "593258147",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
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- Samuel S Messieh, MD
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- Metro Star Services LLC
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- Miami Beach Medical Consultants, LLC. (Clinical Care Medical Centers)
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- Mid Florida Cardiovascular Center, LLC
- Mid-Florida Critical Care Physician Services L L C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.