NPIMap

Organization Active NPI

Village Podiatry Group, LLC.

  • Podiatrist
  • Gainesville, GA
National Provider Identifier
1912443201
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
VILLAGE PODIATRY GROUP, LLC.
Practice address
1224 Sherwood Park Dr NE
Gainesville, GA 30501-3445
Phone
(770) 287-0606
Fax
(770) 287-0159
NPI assigned
Jan 11, 2017
Organization subpart
Yes
Parent organization
EXTREMITY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Mitchell P. Hilsen, DPM
Title
C.O.O.
Phone
(678) 426-2171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

1224 Sherwood Park Dr NE
Gainesville, GA 30501-3445

Mailing address

900 Circle 75 Pkwy.
Suite 900
Atlanta, GA 30339-3084
Phone (678) 426-2171

Other names 1

  • Village Podiatry Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170520000226 GA DME Supplier - Physician - Podiatry 4587646971 Practice locations: Gainesville, GA

National Provider Directory

National Provider Directory
Tax ID family
Village Podiatry Group LLC35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1912443201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CIRCLE 75 PKWY.",
            "address_2": "SUITE 900",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393084",
            "telephone_number": "678-426-2171",
            "fax_number": "404-446-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 SHERWOOD PARK DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013445",
            "telephone_number": "770-287-0606",
            "fax_number": "770-287-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PODIATRY GROUP, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXTREMITY HEALTHCARE, INC.",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "HILSEN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "678-426-2171",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Podiatry Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.