NPIMap

Organization Active NPI

S. Luke Berthelsen DPM, Inc

  • Foot & Ankle Surgery Podiatrist
  • Vista, CA
National Provider Identifier
1821598004
Registry record updated Oct 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5190 Issued in CA
Legal business name
S. LUKE BERTHELSEN DPM, INC
Practice address
2067 W Vista Way Ste 265
Vista, CA 92083-6034
Phone
(760) 463-9155
NPI assigned
Feb 14, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2018

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

Authorized official

Name
Dr. Steven Luke Berthelsen, DPMNPI 1710222443
Title
President
Phone
(760) 463-9155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X E5190 CA Primary

Addresses

Primary practice location

2067 W Vista Way Ste 265
Vista, CA 92083-6034

Mailing address

2067 W Vista Way Ste 265
Vista, CA 92083-6034
Phone (760) 463-9155

Other names 1

  • Foundation Foot & Ankle Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180510000981 CA Part B Supplier - Clinic/Group Practice 0941564371 Receives reassigned benefits from 2 practitioners
Practice locations: Vista, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

2067 W Vista Way
Ste 130
Vista, CA 92083
Phone (760) 631-4000

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540425600000",
    "number": "1821598004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY STE 265",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836034",
            "telephone_number": "760-463-9155",
            "fax_number": "760-712-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY STE 265",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836034",
            "telephone_number": "760-463-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. LUKE BERTHELSEN DPM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-14",
        "last_updated": "2018-10-25",
        "status": "A",
        "authorized_official_last_name": "BERTHELSEN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "LUKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-463-9155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foundation Foot & Ankle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Foundation Foot & Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; 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.