Organization Active NPI

Foot Health Centers PC

  • Foot & Ankle Surgery Podiatrist
  • Maryville, IL
National Provider Identifier
1912930793
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
060-004872 Issued in IL
Legal business name
FOOT HEALTH CENTERS PC
Practice address
122 E Zupan St
Maryville, IL 62062-2010
Phone
(618) 344-4449
Fax
(618) 344-4551
NPI assigned
Jul 8, 2006
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Gina M Reagan
Title
Office Administrator
Phone
(618) 344-4449

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 060-004872 IL Primary

Addresses

Primary practice location

122 E Zupan St
Maryville, IL 62062-2010

Mailing address

122 E Zupan St
Maryville, IL 62062-2010
Phone (618) 344-4449

Other practice location 1

5400 N Illinois St Ste 104
Fairview Heights, IL 62208-3563
Phone (618) 344-4449

Other identifiers 2

IdentifierTypeStateIssuer
060101285OtherILBC/BS GROUP#
CB0674OtherILRAILROAD MEDICARE GROUP#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040513000798 IL Part B Supplier - Clinic/Group Practice 2769472661 Receives reassigned benefits from 4 practitioners
Practice locations: Maryville, IL
O20041218000006 MO Part B Supplier - Clinic/Group Practice 2769472661 Receives reassigned benefits from 4 practitioners
Practice locations: Saint Louis, MO; St Louis, MO
O20100930083814 IL DME Supplier - Physician - Podiatry 2769472661 Practice locations: Maryville, IL

National Provider Directory

National Provider Directory

Locations

1735 Main St
Alton, IL 62002
Phone (618) 462-3888

4325 Alby St
Ste 200
Alton, IL 62002
Phone (618) 462-3888

5400 N Illinois St
Fairview Heights, IL 62208

5400 N Illinois St
Ste 104
Fairview Heights, IL 62208
Phone (618) 235-1500

122 E Zupan St
Maryville, IL 62062
Phone (618) 344-4449

Practitioners & affiliated clinicians

Practitioners 6

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1912930793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 E ZUPAN ST",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620622010",
            "telephone_number": "618-344-4449",
            "fax_number": "618-344-4551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E ZUPAN ST",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620622010",
            "telephone_number": "618-344-4449",
            "fax_number": "618-344-4551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5400 N Illinois St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Fairview Heights",
            "state": "IL",
            "postal_code": "622083563",
            "country_code": "US",
            "telephone_number": "618-344-4449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOOT HEALTH CENTERS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "618-344-4449"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "060-004872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS GROUP#",
            "identifier": "060101285",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP#",
            "identifier": "CB0674",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.