Northwest Foot and Ankle Specialists, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

NORTHWEST FOOT AND ANKLE SPECIALISTS, LLC

Practice address

12900 NE 180TH St Ste 150
Bothell, WA 98011-5778

Phone

(206) 365-5484

Fax

(206) 365-5714

NPI assigned

Jul 15, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Kelly J. Hall, DPMNPI 1205932191

Title

Owner/Staffing Member/Physician

Phone

(206) 365-5484

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

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

• Kelly Jean Hall, DPM

  • Podiatrist
  • Bothell, WA
  • NPI 1205932191
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1790337194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 NE 180TH ST, STE 150",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "98011",
            "telephone_number": "206-365-5484",
            "fax_number": "206-365-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 NE 180TH ST STE 150",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980115778",
            "telephone_number": "206-365-5484",
            "fax_number": "206-365-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST FOOT AND ANKLE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/STAFFING MEMBER/PHYSICIAN",
        "authorized_official_telephone_number": "206-365-5484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1205932191",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1106699",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043268",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5815682",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "HA0967",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TRAKNET",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12900 NE 180th St Ste 150",
            "city": "Bothell",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980115773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Northshore Physical Therapy
• Northshore School District
• Northshore Senior Center
• Northshore Youth and Family Services
• Northstore Youth & Family SVCS
• Northwest Functional Nutrition, LLC
• Northwest Holistic Therapies, P.S.
• Yaw Adjei Ntiamoah
• Amanda Sue Nunnikhoven, LMP
• Maya Isabel Nuno

• Podiatrist in Bothell, WA
• Providers in Bothell, WA by specialty
• Podiatrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.