NPIMap

Organization Active NPI

Wtfootcare, Professional Physician Assistant Corporation

Doing business as WTFootcare, Inc

  • Physician Assistant
  • Rancho Cucamonga, CA
National Provider Identifier
1841818747
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
WTFOOTCARE, PROFESSIONAL PHYSICIAN ASSISTANT CORPORATION
Doing business as
WTFootcare, Inc
Practice address
8972 Appaloosa CT
Rancho Cucamonga, CA 91737-1401
Phone
(909) 274-9143
NPI assigned
Jul 8, 2020
Last updated
Jul 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Stephanie Clark-Poveda, PANPI 1881761120
Title
PA
Phone
(909) 732-8811

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
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

8972 Appaloosa CT
Rancho Cucamonga, CA 91737-1401

Mailing address

8972 Appaloosa CT
Rancho Cucamonga, CA 91737-1401
Phone (909) 274-9143

Other names 1

  • WTFootcare, Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200728001057 CA Part B Supplier - Clinic/Group Practice 2264856905 Receives reassigned benefits from 3 practitioners
Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1841818747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8972 APPALOOSA CT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917371401",
            "telephone_number": "909-274-9143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8972 APPALOOSA CT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917371401",
            "telephone_number": "909-274-9143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WTFOOTCARE, PROFESSIONAL PHYSICIAN ASSISTANT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "CLARK-POVEDA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PA",
        "authorized_official_telephone_number": "909-732-8811",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WTFootcare, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; 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.