NPIMap

Organization Active NPI

Adler Podiatry Clinic PLLC

  • Foot & Ankle Surgery Podiatrist
  • Jacksonville, FL
National Provider Identifier
1689942302
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
ADLER PODIATRY CLINIC PLLC
Practice address
3636 University Blvd S
BLDG C
Jacksonville, FL 32216-4250
Phone
(904) 731-1711
Fax
(904) 731-9270
NPI assigned
Dec 8, 2011
Last updated
Oct 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Authorized official

Name
Carrie Guenther
Title
Office Manager
Phone
(904) 731-1711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X Primary

Addresses

Primary practice location

3636 University Blvd S
BLDG C
Jacksonville, FL 32216-4250

Mailing address

3636 University Blvd S
BLDG C
Jacksonville, FL 32216-4250
Phone (904) 731-1711

Other identifiers 2

IdentifierTypeStateIssuer
002RXOtherFLBCBSFL
DS3051OtherFLRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120110000721 FL Part B Supplier - Clinic/Group Practice 0345416517 Receives reassigned benefits from 5 practitioners
Practice locations: Jacksonville, FL
O20120504000494 FL DME Supplier - Physician - Podiatry 0345416517 Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory
Tax ID family
Adler Podiatry Clinic PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

3636 University Blvd S
Ste C
Jacksonville, FL 32216
Phone (904) 731-1711

Practitioners & affiliated clinicians

Practitioners 5

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": "1323302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1689942302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 UNIVERSITY BLVD S",
            "address_2": "BLDG C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164250",
            "telephone_number": "904-731-1711",
            "fax_number": "904-731-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 UNIVERSITY BLVD S",
            "address_2": "BLDG C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164250",
            "telephone_number": "904-731-1711",
            "fax_number": "904-731-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADLER PODIATRY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-08",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "GUENTHER",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-731-1711"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "002RX",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DS3051",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; 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.