NPIMap

Individual provider Active NPI

Brian P Gradisek, D.P.M.

  • Podiatrist
  • Boulder, CO
National Provider Identifier
1700178092
Registry record updated Jul 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016005597 Issued in IL
Practice address
1400 28TH St Ste 2
Boulder, CO 80303-1096
Phone
(303) 449-2000
Fax
(303) 449-9475
NPI assigned
May 5, 2011
Last updated
Jul 27, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016005597 IL Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 016005597 IL
Foot & Ankle Surgery Podiatrist 213ES0103X 0000766 CO

Addresses

Primary practice location

1400 28TH St Ste 2
Boulder, CO 80303-1096

Mailing address

1400 28TH St Ste 2
Boulder, CO 80303-1096
Phone (303) 449-2000

Other identifiers 1

IdentifierTypeStateIssuer
016005597MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150924001519 CO Practitioner - Podiatry 5698994515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 28TH St
Suite 2
Boulder, CO 80303-1096
Phone (303) 449-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10
Removal of nail tissue17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0000766COMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Foot and Ankle Care of Boulder County Podiatrist CurrentSince May 1, 2023 Accepting new patients
Foot and Ankle Care of Boulder County Podiatrist CurrentSince May 1, 2023 Accepting new patients

Locations

1400 28th St
Ste 2
Boulder, CO 80303
Phone (303) 449-2000

Organizations & group practices 4

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

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1700178092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 28TH ST STE 2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031096",
            "telephone_number": "303-449-2000",
            "fax_number": "303-449-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 28TH ST STE 2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031096",
            "telephone_number": "303-449-2000",
            "fax_number": "303-449-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADISEK",
        "first_name": "BRIAN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-05",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005597",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005597",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CO",
            "license": "0000766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005597",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.