Maikhoi T Pham, DPM, MBA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO3506 Issued in FL

Practice address

538 SE Port St Lucie Blvd
Port St Lucie, FL 34984-5108

Phone

(772) 871-5900

Fax

(772) 871-1197

NPI assigned

Oct 25, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

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

Barry University School of Podiatric Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Conviva Specialty LLCGroup PAC ID 2365729308, 16 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: maikhoi.pham.1@29601.direct.athenahealth.com

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.

• Conviva Specialty, LLC

  • Cardiovascular Disease Physician
  • Miami, FL
  • NPI 1326498676
  Medicare reassignment Care Compare group NPD
• Avron H Lipschitz MD Plastic Surgery LLC

  • Plastic Surgery Physician
  • Stuart, FL
  • NPI 1235410549
  Medicare reassignment NPD

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1811273600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349845108",
            "telephone_number": "772-871-5900",
            "fax_number": "772-871-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 SE PORT ST LUCIE BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349845108",
            "telephone_number": "772-871-5900",
            "fax_number": "772-871-1197"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "903 SE Monterey Commons Blvd",
            "address_purpose": "LOCATION",
            "city": "Stuart",
            "state": "FL",
            "postal_code": "349963339",
            "country_code": "US",
            "telephone_number": "772-266-5003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "MAIKHOI",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DPM, MBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "2029",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318118202",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318118201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9426400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRA",
            "identifier": "P01144991",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Karen Pezzullo, CRTT
• Elisabeth E. Pfirrmann, MSW
• Bettina Phagan, M.A.
• Sarah Anabelle Phajou Louis
• Linh Pham
• Phara Inc
• Susan Lynch Philcox, APRN, PMHNP-BC
• Clive Phillips
• Michele Pittera Phillips, AU.D.
• Vatna Phizeme

• Foot & Ankle Surgery Podiatrist in Port St Lucie, FL
• Providers in Port St Lucie, 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 Nov 13, 2020; 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.