Pocatello Podiatry Associates PA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

P-82 Issued in ID

Legal business name

POCATELLO PODIATRY ASSOCIATES PA

Practice address

1555 E Clark St
Pocatello, ID 83201-4133

Phone

(208) 233-4355

Fax

(208) 233-7198

NPI assigned

Oct 2, 2007

Last updated

Mar 18, 2021By 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

Koree Godfrey

Title

Credentialing

Phone

(208) 233-4355

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ambulatory Foot and Ankle Clinic Other name

Medicare fee-for-service enrollment

Enrolled in ID, WY3 enrollments

Enrollment records 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

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.

• Karson Kert Howard, DPM

  • Foot & Ankle Surgery Podiatrist
  • Pocatello, ID
  • NPI 1992093561

  WY

  Medicare reassignment Care Compare group NPD
• Adam Matthews, DPM

  • Foot & Ankle Surgery Podiatrist
  • Pocatello, ID
  • NPI 1134411408

  WY

  Medicare reassignment Care Compare group NPD
• Kert W Howard, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Pocatello, ID
  • NPI 1245216647
  Medicare reassignment NPD
• Jessica Torrez, DNP, FNP-BC

  • Family Nurse Practitioner
  • Twin Falls, ID
  • NPI 1205307097
  NPD (past)

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1912194085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014133",
            "telephone_number": "208-233-4355",
            "fax_number": "208-233-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014133",
            "telephone_number": "208-233-4355",
            "fax_number": "208-233-7198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCATELLO PODIATRY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "KOREE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "208-233-4355"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "ID",
            "license": "P-82",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004400900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambulatory Foot and Ankle Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ambulatory Foot and Ankle Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ambulatory Foot and Ankle Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Foot & Ankle Surgery Podiatrist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Foot & Ankle Surgery Podiatrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.