Individual provider Active NPI

Catherine M. Rezendes, DPM

  • Podiatrist
  • Live Oak, TX
National Provider Identifier
1720002579
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
1289 Issued in TX
Practice address
12413 Judson Rd
Ste.120
Live Oak, TX 78233-3202
Phone
(210) 655-9965
Fax
(210) 655-9985
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 1289 TX Primary
Foot Surgery Podiatrist 213ES0131X 1289 TX

Addresses

Primary practice location

12413 Judson Rd
Ste.120
Live Oak, TX 78233-3202

Mailing address

12413 Judson Rd
Ste.120
Live Oak, TX 78233-3202
Phone (210) 655-9965

Other identifiers 3

IdentifierTypeStateIssuer
1782880-01MedicaidTX
2596273OtherTXAETNA PROVIDER NUMBER
8F7030OtherTXBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100324000027 TX Practitioner - Podiatry 4981675345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12413 Judson Rd
Suite 120
Live Oak, TX 78233-3262
Phone (210) 655-9965

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue34
Removal of nail tissue47
Removal or shaving of skin growth11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Podiatry Clinics P,a, Podiatrist CurrentSince Nov 1, 1998 Accepting new patients
The Podiatry Group of South Texas, PA Past Accepting new patients

Locations

12413 Judson Rd
Ste 120
Live Oak, TX 78233
Phone (210) 654-0030

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471910400000",
    "number": "1720002579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12413 JUDSON RD",
            "address_2": "STE.120",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333202",
            "telephone_number": "210-655-9965",
            "fax_number": "210-655-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12413 JUDSON RD",
            "address_2": "STE.120",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333202",
            "telephone_number": "210-655-9965",
            "fax_number": "210-655-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZENDES",
        "first_name": "CATHERINE",
        "middle_name": "M.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2016-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "1289",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "TX",
            "license": "1289",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1782880-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "2596273",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "8F7030",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, TX

Sources for this page

Verify at the official NPI Registry.