St. Johns Podiatry & Wound Care Specialists LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

ST. JOHNS PODIATRY & WOUND CARE SPECIALISTS LLC

Practice address

113 Nature Walk Pwky
Ste. 105
Saint Augustine, FL 32092

Phone

(315) 382-5910

NPI assigned

Oct 1, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Daniel A Black, DPMNPI 1407298987

Title

Owner of Tin/Practice

Phone

(315) 382-5910

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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.

• Daniel Alexander Black, DPM

  • Foot & Ankle Surgery Podiatrist
  • Saint Augustine, FL
  • NPI 1407298987
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1801568431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 MORNING MIST LN",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322598511",
            "telephone_number": "315-382-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 NATURE WALK PWKY",
            "address_2": "STE. 105",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "32092",
            "telephone_number": "315-382-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS PODIATRY & WOUND CARE SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER OF TIN/PRACTICE",
        "authorized_official_telephone_number": "315-382-5910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Johns County School District
• St. Johns County School District
• St. Johns County School District
• St. Johns Family Dentistry
• St. Johns Family Dentistry
• St. Johns Wellness Center, LLC
• Sta Birth Collective
• Analee Stallings, AUD
• Peter John Stan, OD
• Robert William Stanborough, PT

• Foot & Ankle Surgery Podiatrist in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.