NPIMap

Organization Active NPI

Medical Center West Podiatry Associates, Inc.

  • Primary Podiatric Medicine Podiatrist
  • Worcester, MA
National Provider Identifier
1821185455
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
2087 Issued in MA
Legal business name
MEDICAL CENTER WEST PODIATRY ASSOCIATES, INC.
Practice address
488 Pleasant St
Worcester, MA 01609-1857
Phone
(508) 755-9573
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Authorized official

Name
Dr. Jonathan F. Ketchum, D.P.M.
Title
President
Phone
(508) 755-9573

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP1101X 2087 MA Primary

Addresses

Primary practice location

488 Pleasant St
Worcester, MA 01609-1857

Mailing address

126 Bushy LN
Rutland, MA 01543-2025
Phone (508) 886-6280

Other identifiers 4

IdentifierTypeStateIssuer
719907OtherMATUFTS HEALTH PLAN
W201440OtherMACIGNA
Y77039OtherMABLUE SHEILD OF MA
9719067MedicaidMA

National Provider Directory

National Provider Directory

Locations

1378 Main St
Worcester, MA 01603
Phone (407) 476-5615

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14852/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1821185455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 BUSHY LN",
            "city": "RUTLAND",
            "state": "MA",
            "postal_code": "015432025",
            "telephone_number": "508-886-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "488 PLEASANT ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091857",
            "telephone_number": "508-755-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER WEST PODIATRY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "KETCHUM",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-755-9573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MA",
            "license": "2087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "719907",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "W201440",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD OF MA",
            "identifier": "Y77039",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9719067",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.