Bryan Fallis

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BRYAN FALLIS

Doing business as

Progressive Podiatry

Practice address

2300 Chamber Center Dr
Suite 100
Lakeside Park, KY 41017-1673

Phone

(859) 331-2440

Fax

(859) 331-2449

NPI assigned

Oct 22, 2009

Last updated

Jan 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bryan V Fallis, DPMNPI 1083606974

Title

Owner

Phone

(859) 331-2440

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Progressive Podiatry Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Bryan Fallis

  dba Progressive Podiatry

  • Podiatrist
  • Cincinnati, OH
  • NPI 1649405259

  9931308517

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Bryan V Fallis, D.P.M.

  • Podiatrist
  • Ft Mitchell, KY
  • NPI 1083606974

  O20100930055065

  Same enrollment

Tax ID family

Bryan Fallis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Bryan Fallis

  • Podiatrist
  • Cincinnati, OH
  • NPI 1740903822
  NPD tax ID

Practitioners 1

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.

• Bryan V Fallis, D.P.M.

  • Podiatrist
  • Ft Mitchell, KY
  • NPI 1083606974
  Authorized official Same address or phone

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1720314966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636389",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630001",
            "telephone_number": "859-557-4260",
            "fax_number": "513-557-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHAMBER CENTER DR",
            "address_2": "SUITE 100",
            "city": "LAKESIDE PARK",
            "state": "KY",
            "postal_code": "410171673",
            "telephone_number": "859-331-2440",
            "fax_number": "859-331-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN FALLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "FALLIS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-331-2440",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "KY",
            "license": "00258",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100096290",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80000151",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Progressive Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Progressive Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natalie S. Adams, DO
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• Joshua M Benge, M.D.
• Concinnity Medical Devices, Inc (Ben Guard)
• Ellen Yass-Reed, M.a. PLLC
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• Christina Friedly, DO
• Jacqueline Leight Reichert Grimes

• Durable Medical Equipment & Medical Supplies in Lakeside Park, KY
• Providers in Lakeside Park, KY by specialty
• Durable Medical Equipment & Medical Supplies in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.