NPIMap

Individual provider Active NPI

John Randall Northrup, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • St Augustine, FL
National Provider Identifier
1891178406
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO3952 Issued in FL
Practice address
1690 US Highway 1 S Ste C
St Augustine, FL 32084-6024
Phone
(904) 436-8001
Fax
(904) 377-6776
NPI assigned
Jun 30, 2015
Last updated
Oct 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PO3952 FL
Foot & Ankle Surgery Podiatrist 213ES0103X PO3952 FL Primary

Addresses

Primary practice location

1690 US Highway 1 S Ste C
St Augustine, FL 32084-6024

Mailing address

1690 US Highway 1 S Ste C
St Augustine, FL 32084-6024
Phone (904) 436-8001

Other practice location 1

9 Pine Cone Dr Ste 101
Palm Coast, FL 32137-8683
Phone (904) 436-8001

Other identifiers 1

IdentifierTypeStateIssuer
101521600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190228000511 FL Practitioner - Podiatry 7113266636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Superior Podiatry LLCGroup PAC ID 6305185828, 2 clinicians

Practice addresses (Care Compare)

1690 US Hwy 1 S
Suite C
St Augustine, FL 32084-6024
Phone 90443680011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.35 of 100Reported as individual
Quality
59.92
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue84
Removal of skin lesions1-10
Removal of nail tissue1065
Removal or shaving of skin growth1004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO3952FLMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Superior Podiatry, LLC Podiatrist CurrentSince Jul 27, 2018 Accepting new patients

Locations

9 Pine Cone Dr
Ste 101
Palm Coast, FL 32137
Phone (386) 255-6116

1690 US Highway 1 S
Ste C
Saint Augustine, FL 32084
Phone (904) 436-8001

100 Whetstone Pl
Ste 204
St Augustine, FL 32086
Phone (217) 720-3144

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18420/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jnorthrup743536@direct.shands.ufl.edu
  • Direct secure messaging: jnorthrupdpm@superiorpodiatry.emadirect.md

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1891178406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 US HIGHWAY 1 S STE C",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320846024",
            "telephone_number": "904-436-8001",
            "fax_number": "904-376-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 US HIGHWAY 1 S STE C",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320846024",
            "telephone_number": "904-436-8001",
            "fax_number": "904-377-6776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Pine Cone Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Palm Coast",
            "state": "FL",
            "postal_code": "321378683",
            "country_code": "US",
            "telephone_number": "904-436-8001",
            "fax_number": "904-376-7761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NORTHRUP",
        "first_name": "JOHN",
        "middle_name": "RANDALL",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO3952",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101521600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.