NPIMap

Organization Active NPI

Ellsworth Foot and Ankle Clinic

  • Podiatrist
  • Salt Lake City, UT
National Provider Identifier
1760151864
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
ELLSWORTH FOOT AND ANKLE CLINIC
Practice address
3130 S Highland Dr # B4
Salt Lake City, UT 84106-3095
Phone
(801) 253-6886
Fax
(801) 253-6888
NPI assigned
Sep 10, 2021
Organization subpart
Yes
Parent organization
ELLSWORTH FOOT AND ANKLE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Ryan Ellsworth, DPMNPI 1104130574
Title
Ceo
Phone
(801) 253-6886

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 Primary

Addresses

Primary practice location

3130 S Highland Dr # B4
Salt Lake City, UT 84106-3095

Mailing address

9980 S 300 W Ste 300
Sandy, UT 84070-3654
Phone (801) 253-6886

Other names 1

  • Summit Foot and Ankle Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220729002452 UT DME Supplier - Physician - PodiatryDME Supplier - Nurse Practitioner 2062778160 Practice locations: Millcreek, UT

National Provider Directory

National Provider Directory
Tax ID family
Ellsworth Foot and Ankle10 organizations share this tax ID, including this one
Part of
Ellsworth Foot and Ankle

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Other NPIs with the same Medicare PAC ID 3

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

Practitioners 6

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": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1760151864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9980 S 300 W STE 300",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703654",
            "telephone_number": "801-253-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 S HIGHLAND DR # B4",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841063095",
            "telephone_number": "801-253-6886",
            "fax_number": "801-253-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLSWORTH FOOT AND ANKLE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLSWORTH FOOT AND ANKLE CLINIC",
        "enumeration_date": "2021-09-10",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "ELLSWORTH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-253-6886",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Foot and Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.