Individual provider Active NPI

Arles Jhan L Rustia, DPM

  • Podiatrist
  • Pembroke Pines, FL
National Provider Identifier
1760945109
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO4408 Issued in FL
Practice address
703 N Flamingo Rd
Pembroke Pines, FL 33028-1006
Phone
(954) 844-1402
NPI assigned
Apr 11, 2019
Last updated
Jun 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X PO4408 FL Primary

Addresses

Primary practice location

703 N Flamingo Rd
Pembroke Pines, FL 33028-1006

Mailing address

281 Cross Ridge Dr
Ponte Vedra, FL 32081-8445
Phone (908) 596-0194

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20220706003071 FL Practitioner - Podiatry 7214279041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Coast Podiatric Surgery and Wound Care LLCGroup PAC ID 1355467721, 2 clinicians

Practice addresses (Care Compare)

1409 Kingsley Ave
Suite 9G
Orange Park, FL 32073-4579
Phone (904) 637-0037

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Removal of tissue886
Removal of skin lesions1-10
Removal of nail tissue500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO4408FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
First Coast Podiatric Surgery and Wound Care LLC Single Specialty CurrentSince Jun 22, 2022 Accepting new patients
First Coast Podiatric Surgery and Wound Care LLC Single Specialty Past Accepting new patients

Locations

1409 Kingsley Ave
Ste 9G
Orange Park, FL 32073
Phone (904) 637-0007

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1760945109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 CROSS RIDGE DR",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320818445",
            "telephone_number": "908-596-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 N FLAMINGO RD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281006",
            "telephone_number": "954-844-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTIA",
        "first_name": "ARLES JHAN",
        "middle_name": "L",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO4408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.