NPIMap

Organization Active NPI

Metroliance Foot and Ankle Group

  • Ambulatory Surgical Clinic/Center
  • Bellevue, WA
National Provider Identifier
1740408293
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
301 Issued in WA
Legal business name
METROLIANCE FOOT AND ANKLE GROUP
Practice address
2950 Northup Way
Suite 115
Bellevue, WA 98004-1406
Phone
(425) 893-8100
Fax
(425) 893-8111
NPI assigned
Apr 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Authorized official

Name
Dr. Tae Soon Park, D.P.M.NPI 1528226263
Title
Medical Director
Phone
(425) 893-8100

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 301 WA Primary

Addresses

Primary practice location

2950 Northup Way
Suite 115
Bellevue, WA 98004-1406

Mailing address

2950 Northup Way
Suite 115
Bellevue, WA 98004-1406
Phone (425) 893-8100

Other names 1

  • Eastside Podiatry ASC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151014003385 WA Part B Supplier - Ambulatory Surgical Center 5698084564 Practice locations: Bellevue, WA

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eastside Podiatry ASCCCN 50C0001073
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Metroliance Foot and Ankle2 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.

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": "1177200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1740408293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 NORTHUP WAY",
            "address_2": "SUITE 115",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041406",
            "telephone_number": "425-893-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 NORTHUP WAY",
            "address_2": "SUITE 115",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041406",
            "telephone_number": "425-893-8100",
            "fax_number": "425-893-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METROLIANCE FOOT AND ANKLE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-22",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TAE SOON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-893-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Podiatry ASC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.