NPIMap

Organization Active NPI

Elite Mobile Wound Care LLC

  • Podiatrist
  • Sandy, OR
National Provider Identifier
1902634256
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
ELITE MOBILE WOUND CARE LLC
Practice address
37569 Highway 26
Sandy, OR 97055-9301
Phone
(503) 668-5210
NPI assigned
Jul 25, 2024
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Trevor Haynes, DPMNPI 1144576224
Title
Owner
Phone
(503) 668-5210

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
Podiatrist 213E00000X Primary

Addresses

Primary practice location

37569 Highway 26
Sandy, OR 97055-9301

Mailing address

37569 Highway 26
Sandy, OR 97055-9301

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240904002048 OR Part B Supplier - Clinic/Group Practice 7113467242 Receives reassigned benefits from 3 practitioners
Practice locations: Sandy, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1902634256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37569 HIGHWAY 26",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970559301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37569 HIGHWAY 26",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970559301",
            "telephone_number": "503-668-5210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MOBILE WOUND CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-668-5210",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.