NPIMap

Organization Active NPI

Kalamazoo Foot Surgery, P.C.

  • Podiatrist
  • Kalamazoo, MI
National Provider Identifier
1780763870
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
KALAMAZOO FOOT SURGERY, P.C.
Practice address
1212 S Park St
Kalamazoo, MI 49001-5600
Phone
(269) 344-0874
Fax
(269) 344-7256
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Authorized official

Name
Rick William Tiller, D.P.M.NPI 1134190614
Title
Doctor
Phone
(269) 344-0874

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 MI Primary

Addresses

Primary practice location

1212 S Park St
Kalamazoo, MI 49001-5600

Mailing address

1212 S Park St
Kalamazoo, MI 49001-5600
Phone (269) 344-0874

Other identifiers 3

IdentifierTypeStateIssuer
480C97640OtherMIBLUE CARE NETWORK
0432570002OtherMIDME
480C97640OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000506 MI Part B Supplier - Clinic/Group Practice 5890692297 Receives reassigned benefits from 6 practitioners
Practice locations: Kalamazoo, MI
O20100930042705 MI DME Supplier - Physician - Podiatry 5890692297 Practice locations: Kalamazoo, MI

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17077/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1780763870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 S PARK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490015600",
            "telephone_number": "269-344-0874",
            "fax_number": "269-344-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S PARK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490015600",
            "telephone_number": "269-344-0874",
            "fax_number": "269-344-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALAMAZOO FOOT SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "TILLER",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "269-344-0874",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "480C97640",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0432570002",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "480C97640",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.