Active NPI
Kurt W Davis, DPM
- Podiatrist
- Vancouver, WA
National Provider Identifier
1790721827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- P000000682
- Practice address
- 2415 SE 165TH Ave
Ste 104
Vancouver, WA 98683 - Phone
- (360) 694-3668
- Fax
- (360) 882-3566
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | P000000682 | WA | Primary |
Addresses
Primary practice location
2415 SE 165TH Ave
Ste 104
Vancouver, WA 98683
Mailing address
2415 SE 165TH Ave
Ste 104
Vancouver, WA 98683
Phone (360) 694-3668
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1121235 | Medicaid | WA | |
| 6444400001 | Other | WA | PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P000000682 | WA | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| On-Site Anesthesia Services Inc | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Ankle & Foot Clinic, PS | Podiatrist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Podiatrist
- Vancouver, WA
- NPI 1285823005
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Certified Registered Nurse Anesthetist
- Lake Oswego, OR
- NPI 1669417176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346889600000",
"number": "1790721827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 SE 165TH AVE",
"address_2": "STE 104",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98683",
"telephone_number": "360-694-3668",
"fax_number": "360-882-3566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 SE 165TH AVE",
"address_2": "STE 104",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98683",
"telephone_number": "360-694-3668",
"fax_number": "360-882-3566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KURT",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2012-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "WA",
"license": "P000000682",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1121235",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "6444400001",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.