Elite Foot & Ankle Associates LLC
Organization Active NPI Foot & Ankle Surgery Podiatrist · Sandy, OR
NPI 1700386992 · NPPES record last updated Nov 4, 2024
Key facts
- NPI
- 1700386992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- ELITE FOOT & ANKLE ASSOCIATES LLC
- Practice address
- 37569 Highway 26
Sandy, OR 97055-9301 - Phone
- (503) 668-5210
- Fax
- (877) 480-9759
- NPI assigned
- Feb 14, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Trevor J Haynes, DPM
- Title
- Owner/Manager
- Phone
- (208) 316-7729
Practitioners 14
-
Trevor J Haynes, D.P.M.
-
Ravneet Sandhu, DPM
-
Frank A Sheaffer, DPM
-
Tyler Belnap, DPM
-
Heather Sullivan, FNP
-
Lance Davis, DC
-
David Alan Dewar, D.C.
-
Myles Knutson, DPM
-
Brian Guy Orahood, DPM
-
Peter Duy Pham, DPM
-
Micah D Tovey, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in OR, WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180403002376 | OR | Part B Supplier - Clinic/Group Practice | 5799047783 |
Receives reassigned benefits from 7 practitioners Practice locations: Beaverton, OR; Canby, OR; Happy Valley, OR; Lake Oswego, OR; Portland, OR; Sandy, OR; Tigard, OR |
| O20180712001660 | OR | DME Supplier - Physician - Podiatry | 5799047783 | Practice locations: Sandy, OR |
| O20231010001498 | WA | Part B Supplier - Clinic/Group Practice | 5799047783 |
Receives reassigned benefits from 1 practitioner Practice locations: White Salmon, WA |
National Provider Directory
Locations
332 NW 1st Ave
Canby, OR 97013
Phone (503) 266-0600
511 SW 10th Ave
Ste 811
Portland, OR 97205
Phone (503) 246-2212
37587 Highway 26
Sandy, OR 97055
Phone (503) 506-0474
37569 Highway 26
Sandy, OR 97055
Phone (503) 668-5210
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FHGCBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | Yes |
Addresses
Primary practice location
37569 Highway 26
Sandy, OR 97055-9301
Mailing address
37569 Highway 26
Sandy, OR 97055-9301
Phone (503) 668-5210
Other practice location 1
332 NW 1st Ave
Canby, OR 97013-3533
Phone (503) 668-5210
Other practice location 2
11815 SW King James Pl Ste 60
King City, OR 97224-2479
Phone (503) 639-8107
Other practice location 3
17200 NW Corridor Ct Ste 108
Beaverton, OR 97006-3295
Phone (503) 292-9252
Other practice location 4
10373 NE Hancock St Ste 118
Portland, OR 97220-3873
Phone (971) 254-8944
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500740646 | Medicaid | OR |
Other providers in Sandy, OR
- Deborah Michele Doan
- Bob Dorsey
- Madison Dougherty
- Drift & Restore Massage Therapy, LLC
- Elizabeth McEvoy Earl
- Elite Mobile Wound Care LLC
- Jenn Elle
- Eric S Lemay RN DC PC
- Jose L Estrada
- Faiz Healing Designs LLC
All providers in Sandy, OR · Foot & Ankle Surgery Podiatrist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.