NPIMap

Organization Active NPI

Otter Tail Podiatry P.C.

  • Podiatrist
  • Fergus Falls, MN
National Provider Identifier
1912286964
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
828 Issued in MN
Legal business name
OTTER TAIL PODIATRY P.C.
Practice address
120 E Junius Ave
Fergus Falls, MN 56537-2819
Phone
(218) 736-6868
Fax
(218) 736-6017
NPI assigned
Aug 9, 2011
Last updated
Aug 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Authorized official

Name
Dr. Marc J Butcher, D.P.M.
Title
President
Phone
(218) 736-6868

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X 828 MN Primary
Primary Podiatric Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213EP1101X 828 MN
Radiology PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ER0200X 828 MN
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 828 MN

Addresses

Primary practice location

120 E Junius Ave
Fergus Falls, MN 56537-2819

Mailing address

120 E Junius Ave
Fergus Falls, MN 56537-2819
Phone (218) 736-6868

Other identifiers 1

IdentifierTypeStateIssuer
1619065398OtherNPI

National Provider Directory

National Provider Directory

Locations

120 E Junius Ave
Fergus Falls, MN 56537
Phone (218) 736-6868

Practitioners & affiliated clinicians

Practitioners 3

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": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1912286964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E JUNIUS AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372819",
            "telephone_number": "218-736-6868",
            "fax_number": "218-736-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E JUNIUS AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372819",
            "telephone_number": "218-736-6868",
            "fax_number": "218-736-6017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTER TAIL PODIATRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "BUTCHER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-736-6868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "828",
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MN",
            "license": "828",
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Radiology",
            "state": "MN",
            "license": "828",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "828",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619065398",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.