Edgewater Beach Foot and Ankle Center, P.C.

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

016002871 Issued in IL

Legal business name

EDGEWATER BEACH FOOT AND ANKLE CENTER, P.C.

Practice address

5331 N Sheridan Rd
Chicago, IL 60640-2531

Phone

(773) 271-0807

Fax

(484) 723-7350

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Benita J Kapnick

Title

Office Manager

Phone

(773) 271-0807

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: ebfa-drcohen@direct.practicefusion.com

Practitioners 8

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

• Robert I. Cohen, D.P.M.

  • Podiatrist
  • Evanston, IL
  • NPI 1649239740
  Medicare reassignment NPD
• Andrew Jesse Engel, MD

  • Pain Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1083776223
  NPD (past)
• David Brian Hiltzik, D.P.M

  • Foot & Ankle Surgery Podiatrist
  • Waukegan, IL
  • NPI 1235238155
  NPD (past)
• Denise Petenzi, DPM

  • Podiatrist
  • Chicago, IL
  • NPI 1457329708
  NPD (past)
• Jeremy A Schwartz, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Evanston, IL
  • NPI 1861739484
  NPD (past)
• Anusak Seriruk, DPM

  • Podiatrist
  • Chicago, IL
  • NPI 1902970940
  NPD (past)
• Richard J Weiss, DPM

  • Podiatrist
  • Evanston, IL
  • NPI 1902840820
  NPD (past)
• Eliezer Soto, M.D.

  • Interventional Pain Medicine Physician
  • Vero Beach, FL
  • NPI 1598950990
  NPD (past)

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1780801548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 AUSTIN ST STE 508",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023445",
            "telephone_number": "773-271-0807",
            "fax_number": "484-723-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402531",
            "telephone_number": "773-271-0807",
            "fax_number": "484-723-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER BEACH FOOT AND ANKLE CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "KAPNICK",
        "authorized_official_first_name": "BENITA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-271-0807",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "IL",
            "license": "016002871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "480021114",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "60000959",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016002871",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "EBFA-DrCohen@direct.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "Direct Message to EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Chicago",
            "address_1": "5331 N Sheridan Rd",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606402531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Edgebrook Foot & Ankle Clinic, Inc
• Edgebrook Open MRI Inc
• Edgebrook Vision Center LLC
• Robert Reynolds Edger, MD
• Cole Dreskin Edgerton
• Edgewater Chiropractic LLC
• Edgewater Rehabilitation Center
• Edgewater Satellite Senior Center
• Christopher Kirkwood Edginton, D.C.
• James F. Edgren, LCPC

• Primary Podiatric Medicine Podiatrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Primary Podiatric Medicine Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.