NPIMap

Organization Active NPI

David Gannon DPM LLC

Doing business as Shore Foot & Ankle

  • Foot & Ankle Surgery Podiatrist
  • Berlin, MD
National Provider Identifier
1861415200
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
01311 Issued in MD
Legal business name
DAVID GANNON DPM LLC
Doing business as
Shore Foot & Ankle
Practice address
9956 N Main St
Suite #5
Berlin, MD 21811-1077
Phone
(410) 629-0222
Fax
(410) 629-0225
NPI assigned
Jul 26, 2006
Last updated
Nov 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Authorized official

Name
Dr. David Gannon, D.P.M.NPI 1376521492
Title
Podiatrist/Sole Owner
Phone
(410) 629-0222

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 Podiatrist 213ES0103X 01311 MD Primary

Addresses

Primary practice location

9956 N Main St
Suite #5
Berlin, MD 21811-1077

Mailing address

9956 N Main St
Suite #5
Berlin, MD 21811-1077
Phone (410) 629-0222

Other identifiers 3

IdentifierTypeStateIssuer
DN7994OtherMDRAIL ROAD MEDICARE GROUP PTAN
6031730001OtherDME
4150953-00MedicaidMD

Other names 1

  • Shore Foot & Ankle Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071105000090 MD Part B Supplier - Clinic/Group Practice 5294822433 Receives reassigned benefits from 1 practitioner
Practice locations: Berlin, MD
O20100930079474 MD DME Supplier - Physician - Podiatry 5294822433 Practice locations: Berlin, MD
O20130708000054 DE Part B Supplier - Clinic/Group Practice 5294822433 Receives reassigned benefits from 1 practitioner
Practice locations: Ocean View, DE

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259539200000",
    "number": "1861415200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9956 N MAIN ST",
            "address_2": "SUITE #5",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111077",
            "telephone_number": "410-629-0222",
            "fax_number": "410-629-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9956 N MAIN ST",
            "address_2": "SUITE #5",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111077",
            "telephone_number": "410-629-0222",
            "fax_number": "410-629-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID GANNON DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2009-11-30",
        "status": "A",
        "authorized_official_last_name": "GANNON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PODIATRIST/SOLE OWNER",
        "authorized_official_telephone_number": "410-629-0222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MD",
            "license": "01311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE GROUP PTAN",
            "identifier": "DN7994",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "6031730001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4150953-00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shore Foot & Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; 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.