NPIMap

Organization Active NPI

Active Foot and Ankle Care LLC

  • Podiatric Clinic/Center
  • Greenville, OH
National Provider Identifier
1881872273
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
License
36003402 Issued in OH
Legal business name
ACTIVE FOOT AND ANKLE CARE LLC
Practice address
828 Central Ave
Greenville, OH 45331-1206
Phone
(937) 875-2526
Fax
(937) 459-5433
NPI assigned
Feb 7, 2008
Last updated
Dec 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Chad Liette
Title
Office Manager
Phone
(937) 875-2526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatric Clinic/Center 261QP1100X 36003402 OH Primary

Addresses

Primary practice location

828 Central Ave
Greenville, OH 45331-1206

Mailing address

300 S Dorset Rd
Troy, OH 45373-2635
Phone (937) 875-2526

Other identifiers 1

IdentifierTypeStateIssuer
2543279MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080321000240 OH Part B Supplier - Clinic/Group Practice 1557447216 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
Practice locations: Troy, OH

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

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

Locations

2 E Woodside Dr
Arcanum, OH 45304
Phone (937) 692-6113

Practitioners & affiliated clinicians

Practitioners 5

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": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1881872273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S DORSET RD",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453732635",
            "telephone_number": "937-875-2526",
            "fax_number": "937-459-5433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 CENTRAL AVE",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453311206",
            "telephone_number": "937-875-2526",
            "fax_number": "937-459-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FOOT AND ANKLE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "LIETTE",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "937-875-2526"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "OH",
            "license": "36003402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2543279",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.