Lake Wales Foot and Ankle Care, Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

LAKE WALES FOOT AND ANKLE CARE, INC

Practice address

408 S 1St St
Highland Meadows
Lake Wales, FL 33853-4146

Phone

(863) 676-1710

NPI assigned

May 18, 2016

Last updated

Sep 26, 2016By 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. Prerna Alfa Mall, DPMNPI 1043652290

Title

President

Phone

(863) 676-1710

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DHEECD

Practitioners 2

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.

• Prerna Alfa Mall, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lake Wales, FL
  • NPI 1043652290
  Medicare reassignment Care Compare group Authorized official
• Marlon Osbourne, M.D.

  • Anatomic Pathology Physician
  • Pompano Beach, FL
  • NPI 1295092583
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1770930919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 WOODLARK DR",
            "address_2": "HIGHLAND MEADOWS",
            "city": "HAINES CITY",
            "state": "FL",
            "postal_code": "338447745",
            "telephone_number": "863-676-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S 1ST ST",
            "address_2": "HIGHLAND MEADOWS",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534146",
            "telephone_number": "863-676-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES FOOT AND ANKLE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "MALL",
        "authorized_official_first_name": "PRERNA",
        "authorized_official_middle_name": "ALFA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-676-1710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Wales Charter Schools Inc
• Lake Wales Chiropractic Center Inc
• Lake Wales Clinic Corp
• Lake Wales Dental Associates
• Lake Wales Emergency Physicians, LLC
• Lake Wales Healthcare LLC (Grace Healthcare of Lake Wales)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Medial Center
• Lake Wales Medical Imaging Center One, Inc

• Foot & Ankle Surgery Podiatrist in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.