NPIMap

Organization Active NPI

Advanced Foot Care Center, LLC

  • Foot & Ankle Surgery Podiatrist
  • Thorofare, NJ
National Provider Identifier
1699079665
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
25MD00273100 Issued in NJ
Legal business name
ADVANCED FOOT CARE CENTER, LLC
Practice address
204 Grove Ave
Suite G
Thorofare, NJ 08086-2557
Phone
(856) 579-8674
Fax
(856) 579-8676
NPI assigned
Jan 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Dr. Joseph Anthony Megara III, DPMNPI 1770650947
Title
Managing Memeber
Phone
(856) 579-8674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 25MD00273100 NJ Primary

Addresses

Primary practice location

204 Grove Ave
Suite G
Thorofare, NJ 08086-2557

Mailing address

204 Grove Ave
Suite G
Thorofare, NJ 08086-2557
Phone (856) 579-8674

Other identifiers 1

IdentifierTypeStateIssuer
240449OtherNJMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120611000047 NJ Part B Supplier - Clinic/Group Practice 1658535380 Receives reassigned benefits from 6 practitioners
Practice locations: Pennsville, NJ; West Deptford, NJ
O20120928000532 NJ DME Supplier - Physician - Podiatry 1658535380 Practice locations: West Deptford, NJ

National Provider Directory

National Provider Directory

Locations

204 Grove Ave
Ste G
West Deptford, NJ 08086
Phone (856) 579-8674

608 N Broad St
Ste 125
Woodbury, NJ 08096
Phone (856) 579-8674

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1699079665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 GROVE AVE",
            "address_2": "SUITE G",
            "city": "THOROFARE",
            "state": "NJ",
            "postal_code": "080862557",
            "telephone_number": "856-579-8674",
            "fax_number": "856-579-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 GROVE AVE",
            "address_2": "SUITE G",
            "city": "THOROFARE",
            "state": "NJ",
            "postal_code": "080862557",
            "telephone_number": "856-579-8674",
            "fax_number": "856-579-8676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "MEGARA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING MEMEBER",
        "authorized_official_telephone_number": "856-579-8674",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00273100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "240449",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thorofare, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.