Lake Erie Podiatry, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

SC004630L Issued in PA

Legal business name

LAKE ERIE PODIATRY, LLC

Practice address

3910 Caughey Rd Ste 130
Erie, PA 16506

Phone

(814) 833-3668

Fax

(888) 329-6120

NPI assigned

Dec 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael A Ruiz, DPMNPI 1114901881

Title

Manager

Phone

(814) 833-3668

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18052/brand/1/csg/1/fhir/r4

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael A Ruiz, DPM

  • Foot & Ankle Surgery Podiatrist
  • Erie, PA
  • NPI 1114901881
  Medicare reassignment NPD Authorized official
• Robert F. Bauer, DPM

  • Podiatrist
  • Erie, PA
  • NPI 1174759310
  NPD (past)
• Mary Blackford, LCSW

  • Clinical Social Worker
  • Erie, PA
  • NPI 1891240750
  NPD (past)
• Richard Chadwick Blackford, PH.D.

  • Clinical Psychologist
  • Erie, PA
  • NPI 1053318360
  NPD (past)
• Amy Elizabeth Boxer, NCC

  • Counselor
  • Erie, PA
  • NPI 1831769496
  NPD (past)
• Meagan Jennifer Brown, LPC

  • Professional Counselor
  • Erie, PA
  • NPI 1720612385
  NPD (past)
• Corissa Claar, LSW

  • Social Worker
  • Erie, PA
  • NPI 1881351096
  NPD (past)
• Christy Jo Nyakana, MSW, LCSW

  • Clinical Social Worker
  • Erie, PA
  • NPI 1639375751
  NPD (past)
• Lisa J Schening, PH.D.

  • Psychologist
  • Edinboro, PA
  • NPI 1649241266
  NPD (past)
• Amanda White, PSYD

  • Psychologist
  • Erie, PA
  • NPI 1487025433
  NPD (past)
• Mikaela McKee, LICENSED SOCIAL WORK

  • Social Worker
  • Hamburg, NY
  • NPI 1487199808
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533859200000",
    "number": "1922164409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 CAUGHEY RD STE 130",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165064097",
            "telephone_number": "814-833-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 CAUGHEY RD STE 130",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "16506",
            "telephone_number": "814-833-3668",
            "fax_number": "888-329-6120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1444 W 38th St",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165082346",
            "country_code": "US",
            "telephone_number": "814-866-5141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE ERIE PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2018-08-10",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "814-833-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC004630L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RRB",
            "identifier": "480035188",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019415170002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Erie Home Health Care LLC
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• Lake Erie Music Therapy LLC
• Lake Erie OB-GYN Inc
• Lake Erie Orthopaedics LLC
• Lake Erie Spine and Injury Center
• Lake Erie Womens Center
• Lake Shore Fire Department
• Jessica Elaine Lake, MS, RDN, LD
• Lakeland Area Hospice LP

• Foot & Ankle Surgery Podiatrist in Erie, PA
• Providers in Erie, PA by specialty
• Foot & Ankle Surgery Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; 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.