Jeffrey Craig Pellersels, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

473 Issued in MN

Practice address

563 Bielenberg Dr
Suite 150
Woodbury, MN 55125-4425

Phone

(651) 457-4665

Fax

(651) 457-3115

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Foot & Ankle Clinics Professional name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

College of Podiatric Med and Surgery, Des Moines University, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foot and Ankle Clinics, PAGroup PAC ID 3678506425, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Foot & Ankle Clinics PA

  • Podiatrist
  • Woodbury, MN
  • NPI 1801836234
  Medicare reassignment Care Compare group NPD Authorized official
• Woodbury Surgical Suites, LLC

  • Ambulatory Surgical Clinic/Center
  • Woodbury, MN
  • NPI 1477978310
  NPD

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1790730380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "563 BIELENBERG DR",
            "address_2": "SUITE 150",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254425",
            "telephone_number": "651-457-4665",
            "fax_number": "651-457-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "563 BIELENBERG DR",
            "address_2": "SUITE 150",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254425",
            "telephone_number": "651-457-4665",
            "fax_number": "651-457-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLERSELS",
        "first_name": "JEFFREY",
        "middle_name": "CRAIG",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "473",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "668-025",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "473",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WI",
            "license": "668-025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944325800",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43214500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FOOT",
            "last_name": "& ANKLE CLINICS",
            "credential": "PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• James Pederson
• Maria T Pederson, CNM
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• Lori Peiffer, L.P.
• Ashley Lynn Peine, PA-C
• Penticoff Community Counseling, Inc.
• Renee Marie Penticoff, PSY.D.
• Peoplefirst Clinic PLLC
• Allison Peper
• Scott Randall Pepin, M.D.

• Podiatrist in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Podiatrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.