NPIMap

Organization Active NPI

Institute for Corrective Surgery of the Foot & Ankle, Inc.

  • Ambulatory Surgical Clinic/Center
  • Waycross, GA
National Provider Identifier
1720023237
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
148-201 Issued in GA
Legal business name
INSTITUTE FOR CORRECTIVE SURGERY OF THE FOOT & ANKLE, INC.
Practice address
2003 Alice St
Waycross, GA 31501-6209
Phone
(912) 283-7596
Fax
(912) 283-1618
NPI assigned
Jun 18, 2006
Last updated
Aug 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Authorized official

Name
David P Murphy, D.P.M.NPI 1194755447
Title
Medical Director
Phone
(912) 283-6471

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
Ambulatory Surgical Clinic/Center 261QA1903X 148-201 GA Primary

Addresses

Primary practice location

2003 Alice St
Waycross, GA 31501-6209

Mailing address

501 W Oneida St
Waycross, GA 31501-5337
Phone (912) 283-7596

Other identifiers 3

IdentifierTypeStateIssuer
490004800OtherGARAILROAD MEDICARE
148-201OtherGAGA STATE PERMIT
000894605AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170501001250 GA Part B Supplier - Clinic/Group Practice 0840577888 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hinesville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720023237. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001173

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
INSTITUTE FOR CORR SURG FOOT & ANKLE, INC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Sep 15, 2000
Last certification
Jan 15, 2020
Ownership / control type
Proprietary
Facility address
2003 Alice Street
Waycross, GA 31501

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Hospital Authority of Liberty County3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1720023237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W ONEIDA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015337",
            "telephone_number": "912-283-7596",
            "fax_number": "912-283-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315016209",
            "telephone_number": "912-283-7596",
            "fax_number": "912-283-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR CORRECTIVE SURGERY OF THE FOOT & ANKLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "912-283-6471",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "148-201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004800",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA STATE PERMIT",
            "identifier": "148-201",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000894605A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.