Pro Podiatry, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016005106 Issued in IL

Legal business name

PRO PODIATRY, LLC

Doing business as

Premier Podiatry

Practice address

2501 E College Ave Ste C
Bloomington, IL 61704-2484

Phone

(309) 807-0384

NPI assigned

Dec 7, 2016

Last updated

Sep 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Scott Oconnor, DPMNPI 1992792261

Title

Member

Phone

(309) 807-0384

Specialties & licenses 1

Addresses

Other names 1

• Premier Podiatry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott B O'Connor, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Pontiac, IL
  • NPI 1992792261
  NPD Authorized official

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1770027930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W REYNOLDS ST STE A",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 E COLLEGE AVE STE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042484",
            "telephone_number": "309-807-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "309-807-0384",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Foot & Ankle Surgery Podiatrist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.