NPIMap

Individual provider Active NPI

David Jason Ellenbogen, DPM

  • Foot & Ankle Surgery Podiatrist
  • Charlotte, NC
National Provider Identifier
1831222090
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
615 Issued in NC
Practice address
10035 Park Cedar Dr Ste 100
Charlotte, NC 28210-8910
Phone
(704) 442-9011
Fax
(704) 625-9484
NPI assigned
Mar 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine Podiatrist 213EP1101X 615 NC
Foot Surgery Podiatrist 213ES0131X 615 NC
Foot & Ankle Surgery Podiatrist 213ES0103X 615 NC Primary

Addresses

Primary practice location

10035 Park Cedar Dr Ste 100
Charlotte, NC 28210-8910

Mailing address

10035 Park Cedar Dr Ste 100
Charlotte, NC 28210-8910
Phone (704) 442-9011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160527001372 NC Practitioner - Podiatry 6709986581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10035 Park Cedar Dr
Suite 100
Charlotte, NC 28210-8910
Phone (704) 442-9011

Hospital & facility affiliations

  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue285
Removal of skin lesions1-10
Removal of nail tissue45
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
615NCMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Charlotte Limb Preservation & Diabetic Foot Center PLLC Primary Podiatric Medicine CurrentSince Feb 9, 2022 Accepting new patients
Charlotte Limb Preservation & Diabetic Foot Center Foot & Ankle Surgery Current Accepting new patients
Prohealth Care Associates LLP Past Accepting new patients
Ny Foot & Ankle Specialist DPM PC Primary Podiatric Medicine PastSince May 18, 2008 Accepting new patients
Nyconn Orthopaedic & Rehabalitation Specialists, PLLC Past Accepting new patients

Locations

10035 Park Cedar Dr
Ste 100
Charlotte, NC 28210
Phone (704) 442-9011

Interoperability endpoints

  • Direct secure messaging: dellenb@charlottelimb.emadirect.md

Organizations & group practices 5

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1831222090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10035 PARK CEDAR DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108910",
            "telephone_number": "704-442-9011",
            "fax_number": "704-625-9484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10035 PARK CEDAR DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108910",
            "telephone_number": "704-442-9011",
            "fax_number": "704-625-9484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBOGEN",
        "first_name": "DAVID",
        "middle_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-02-14",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NC",
            "license": "615",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NC",
            "license": "615",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NC",
            "license": "615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.