NPIMap

Organization Active NPI

Sturbridge Foot Care, PC

  • Podiatrist
  • Sturbridge, MA
National Provider Identifier
1740403955
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2129 Issued in MA
Legal business name
STURBRIDGE FOOT CARE, PC
Practice address
118 Main St
Suite 4
Sturbridge, MA 01566-1533
Phone
(508) 347-4900
Fax
(508) 347-9339
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Michael Charles JedrzynskiNPI 1417965369
Title
President
Phone
(508) 347-4900

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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 2129 MA Primary

Addresses

Primary practice location

118 Main St
Suite 4
Sturbridge, MA 01566-1533

Mailing address

118 Main St
Suite 4
Sturbridge, MA 01566-1533
Phone (508) 347-4900

Other identifiers 9

IdentifierTypeStateIssuer
9706194MedicaidMA
983819OtherNETWORK HEALTH
W20203301OtherCIGNA
687-470OtherTUFTS
2574157OtherAETNA US HEALTHCARE
55384OtherFALLON
27-02436OtherUNITED HEALTH PLANS
333414OtherHARVARD PILGRIM
Y77291OtherBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

118 Main St
Ste 4
Sturbridge, MA 01566
Phone (508) 347-4900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1740403955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 MAIN ST",
            "address_2": "SUITE 4",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661533",
            "telephone_number": "508-347-4900",
            "fax_number": "508-347-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MAIN ST",
            "address_2": "SUITE 4",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661533",
            "telephone_number": "508-347-4900",
            "fax_number": "508-347-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STURBRIDGE FOOT CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "JEDRZYNSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-347-4900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MA",
            "license": "2129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9706194",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "983819",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "W20203301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "687-470",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "2574157",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "55384",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH PLANS",
            "identifier": "27-02436",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "333414",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y77291",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturbridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.