NPIMap

Organization Active NPI

Metroliance Foot and Ankle Group

  • Foot & Ankle Surgery Podiatrist
  • Bellevue, WA
National Provider Identifier
1750796579
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO 60234756 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
Jul 1, 2014
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. Taesoon Park, DPMNPI 1528226263
Title
Manager/Owner
Phone
(206) 707-4747

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 PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PO 60234756 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 Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151020002744 WA Part B Supplier - Clinic/Group Practice 5698084564 Receives reassigned benefits from 1 practitioner
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).

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.

Locations

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

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": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1750796579",
    "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",
            "fax_number": "425-893-8111"
        },
        {
            "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": "2014-07-01",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TAESOON",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "206-707-4747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": "PO 60234756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Podiatry Clinic",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.