NPIMap

Organization Active NPI

Breck Tiernan PC

Doing business as Advanced Foot and Ankle Center of Joliet

  • Foot & Ankle Surgery Podiatrist
  • Joliet, IL
National Provider Identifier
1730354382
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016005321 Issued in IL
Legal business name
BRECK TIERNAN PC
Doing business as
Advanced Foot and Ankle Center of Joliet
Practice address
350 Houbolt Rd
Suite 104
Joliet, IL 60431-8305
Phone
(815) 553-0990
Fax
(815) 553-0991
NPI assigned
Apr 24, 2008
Last updated
Oct 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Authorized official

Name
Dr. Breck Michael Tiernan, DPMNPI 1861614380
Title
Owner
Phone
(815) 553-0990

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
Foot & Ankle Surgery Podiatrist 213ES0103X 016005321 IL Primary

Addresses

Primary practice location

350 Houbolt Rd
Suite 104
Joliet, IL 60431-8305

Mailing address

350 Houbolt Rd
Suite 104
Joliet, IL 60431-8305
Phone (815) 553-0990

Other names 1

  • Advanced Foot and Ankle Center of Joliet Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090217000181 IL Part B Supplier - Clinic/Group Practice 6901961465 Receives reassigned benefits from 5 practitioners
Practice locations: Joliet, IL; Orland Park, IL
O20240625000985 IL DME Supplier - Physician - Podiatry 6901961465 Practice locations: Joliet, IL

National Provider Directory

National Provider Directory

Locations

800 Biesterfield Rd
Ste 3004
Elk Grove Vlg, IL 60007
Phone (847) 352-0200

350 Houbolt Rd
Ste 104
Joliet, IL 60431
Phone (815) 553-0990

Practitioners & affiliated clinicians

Practitioners 8

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": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1730354382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 HOUBOLT RD",
            "address_2": "SUITE 104",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604318305",
            "telephone_number": "815-553-0990",
            "fax_number": "815-553-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOUBOLT RD",
            "address_2": "SUITE 104",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604318305",
            "telephone_number": "815-553-0990",
            "fax_number": "815-553-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECK TIERNAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "TIERNAN",
        "authorized_official_first_name": "BRECK",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-553-0990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Foot and Ankle Center of Joliet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.