Active Foot Care, Inc.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

P02326 Issued in FL

Legal business name

ACTIVE FOOT CARE, INC.

Practice address

2563 Huntcliff Lane
Panama City, FL 32405-4902

Phone

(850) 769-1055

Fax

(850) 769-1434

NPI assigned

Apr 11, 2008

Organization subpart

Yes

Parent organization

ACTIVE FOOT CAREAs reported in NPPES

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

Authorized official

Name

Dr. Jalal K Sidani, DPMNPI 1902893985

Title

Podiatrist

Phone

(850) 769-1055

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jalal K Sidani DPM Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Active Foot Care

Locations

Practitioners 1

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

• Jalal K Sidani, DPM

  • Podiatrist
  • Panama City, FL
  • NPI 1902893985

  FL, Podiatrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1861665770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2563 HUNTCLIFF LANE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054902",
            "telephone_number": "850-769-1055",
            "fax_number": "850-769-1434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2563 HUNTCLIFF LANE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054902",
            "telephone_number": "850-769-1055",
            "fax_number": "850-769-1434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FOOT CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACTIVE FOOT CARE",
        "enumeration_date": "2008-04-11",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "SIDANI",
        "authorized_official_first_name": "JALAL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "850-769-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "P02326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390159900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jalal K Sidani DPM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Panama City, FL
• Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.