Southern Oregon Foot & Ankle, LLC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

Legal business name

SOUTHERN OREGON FOOT & ANKLE, LLC

Practice address

1904 E Barnett Rd
Medford, OR 97504-8262

Phone

(541) 776-3338

Fax

(541) 776-4979

NPI assigned

Sep 6, 2007

Last updated

Sep 16, 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

Evan Chard Merrill, DPMNPI 1528166485

Title

Owner

Phone

(541) 776-3338

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

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.

• Evan Chard Merrill, DPM

  • Foot Surgery Podiatrist
  • Meridian, ID
  • NPI 1528166485

  OR

  Medicare reassignment Care Compare group NPD Authorized official
• Mitchell Bryan Booth, DPM

  • Foot & Ankle Surgery Podiatrist
  • Medford, OR
  • NPI 1659020949
  Medicare reassignment Care Compare group NPD
• Devin Dimond, DPM

  • Foot & Ankle Surgery Podiatrist
  • Medford, OR
  • NPI 1134521750
  Medicare reassignment Care Compare group NPD
• Chase Kirk Christensen, DPM

  • Podiatrist
  • West Jordan, UT
  • NPI 1649894569

  OR

  Medicare reassignment Care Compare group NPD
• Adam James Gerber, DPM

  • Podiatrist
  • Caldwell, ID
  • NPI 1780029231

  OR

  Medicare reassignment NPD

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1891980546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1904 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048262",
            "telephone_number": "541-776-3338",
            "fax_number": "541-776-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048262",
            "telephone_number": "541-776-3338",
            "fax_number": "541-776-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON FOOT & ANKLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "MERRILL",
        "authorized_official_first_name": "EVAN",
        "authorized_official_middle_name": "CHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-776-3338",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243148",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP #",
            "identifier": "891269000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Oregon Education Service District
• Southern Oregon Education Service District
• Southern Oregon Education Service District
• Southern Oregon Endodontics, PC
• Southern Oregon Float Spa, LLC
• Southern Oregon Friends of Hospice (Celia's House in Holmes Park)
• Southern Oregon Gynecology LLC
• Southern Oregon Hospitalists PC
• Southern Oregon Internal Medicine
• Southern Oregon Medical Clinic LLC

• Foot Surgery Podiatrist in Medford, OR
• Providers in Medford, OR by specialty
• Foot Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.