Peninsula Foot and Ankle Clinic PLLC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

PENINSULA FOOT AND ANKLE CLINIC PLLC

Practice address

630 E 8TH St
Port Angeles, WA 98362-6224

Phone

(425) 286-5686

NPI assigned

Jul 9, 2020

Last updated

Sep 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Austin Friswold, DPMNPI 1346767258

Title

Physician

Phone

(425) 286-5686

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Locations

Practitioners 2

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.

• Austin G Friswold, DPM

  • Podiatrist
  • Saginaw, MI
  • NPI 1346767258

  WA

  Medicare reassignment NPD Authorized official
• Bradley M Pederson, DPM

  • Podiatrist
  • Port Angeles, WA
  • NPI 1598851081
  NPD (past)

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1861010548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 ROOK DR",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983622777",
            "telephone_number": "425-286-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626224",
            "telephone_number": "425-286-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA FOOT AND ANKLE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "FRISWOLD",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "425-286-5686",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley M Pederson, DPM
• Paul E Pederson, M.D.
• Peninsula Behavioral Health
• Peninsula Childrens Clinic Inc
• Peninsula Family Hearing
• Peninsula Integrative Chiropractic
• Peninsula Sleep Solutions
• Gwen Pennington
• Edward Kenneth Perez
• Nicole Jacqueline Perez, RBT, CBT

• Podiatric Clinic/Center in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Podiatric Clinic/Center in Washington

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