Regional Foot Center LTD

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

16005103 Issued in IL

Legal business name

REGIONAL FOOT CENTER LTD

Practice address

1301 Deerpath Road
Charleston, IL 61920-8734

Phone

(217) 348-3339

Fax

(217) 348-3340

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

John Robert Killough, DPMNPI 1790875417

Title

Owner/Podiatrist

Phone

(217) 348-3339

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Robert Killough, DPM

  • Podiatrist
  • Charleston, IL
  • NPI 1790875417
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1770681330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 DEERPATH ROAD",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619208734",
            "telephone_number": "217-348-3339",
            "fax_number": "217-348-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 DEERPATH ROAD",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619208734",
            "telephone_number": "217-348-3339",
            "fax_number": "217-348-3340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL FOOT CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "KILLOUGH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "217-348-3339",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IL",
            "license": "16005103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8958903",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "P00082665",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "015-32005",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005103",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatric Clinic/Center in Charleston, IL
• Providers in Charleston, IL by specialty
• Podiatric Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.