NPIMap

Organization Active NPI

Kelley a. Gillroy-Gill

Doing business as Cascade Foot and Ankle Clinic

  • Foot & Ankle Surgery Podiatrist
  • Olympia, WA
National Provider Identifier
1750775037
Registry record updated May 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO 60507941 Issued in WA
Legal business name
KELLEY A. GILLROY-GILL
Doing business as
Cascade Foot and Ankle Clinic
Practice address
165 Lilly Rd NE
Olympia, WA 98506-5086
Phone
(360) 438-9092
Fax
(360) 438-3906
NPI assigned
Mar 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2016

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

Authorized official

Name
Dr. Kelley Ann Gillroy-Gill, D.P.M.
Title
Podiatrist
Phone
(623) 238-4022

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO 60507941 WA Primary

Addresses

Primary practice location

165 Lilly Rd NE
Olympia, WA 98506-5086

Mailing address

165 Lilly Rd NE Ste a
Olympia, WA 98506-5086
Phone (360) 438-9092

Other identifiers 1

IdentifierTypeStateIssuer
7392670001OtherWAPTAN

Other names 1

  • Cascade Foot and Ankle Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150723006776 WA Part B Supplier - Clinic/Group Practice 9436462231 Receives reassigned benefits from 1 practitioner
Practice locations: Olympia, WA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

165 Lilly Rd NE
Olympia, WA 98506
Phone (360) 438-9092

165 Lilly Rd NE
Ste A
Olympia, WA 98506
Phone (360) 438-9092

Practitioners & affiliated clinicians

Practitioners 4

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": "1427155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464134400000",
    "number": "1750775037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 LILLY RD NE STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065086",
            "telephone_number": "360-438-9092",
            "fax_number": "360-438-3906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065086",
            "telephone_number": "360-438-9092",
            "fax_number": "360-438-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY A. GILLROY-GILL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-24",
        "last_updated": "2016-05-25",
        "status": "A",
        "authorized_official_last_name": "GILLROY-GILL",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "623-238-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO 60507941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "7392670001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cascade Foot and Ankle Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; 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.