Peter Redko, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

E4517 Issued in CA

Practice address

1400 Professional Drive
Suite 102
Petaluma, CA 94954-5110

Phone

(707) 769-8481

Fax

(707) 769-0751

NPI assigned

Nov 24, 2006

Last updated

Nov 24, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Temple University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Bay Foot & Ankle Center Inc

  • Podiatrist
  • Petaluma, CA
  • NPI 1912017021
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259020800000",
    "number": "1750456687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 PROFESSIONAL DR",
            "address_2": "SUITE 102",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949545110",
            "telephone_number": "707-769-8481",
            "fax_number": "707-769-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PROFESSIONAL DRIVE",
            "address_2": "SUITE 102",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949545110",
            "telephone_number": "707-769-8481",
            "fax_number": "707-769-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDKO",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2009-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liza Jill Ravitz, LIZA RAVITZ, PH.D
• Ian Robert Rawlinson, LIC.AC.
• Reece Chandler Raykovitz, IDHS
• Lilia Rechin
• Recovery Transportation Systems
• Redwood Regional Medical Group, Inc. (Redwood Regional Oncology Center)
• Redwood Regional Medical Group, Inc.
• Redwood Regional Medical Group, Inc. (Redwood Regional Oncology Center)
• Fiona Redwood, M.D.
• Carla Marcella Reece, MFT

• Podiatrist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.