NPIMap

Organization Active NPI

Lake Erie Podiatry, LLC

  • Foot & Ankle Surgery Podiatrist
  • Erie, PA
National Provider Identifier
1922164409
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X SC004630L PA Primary

Addresses

Primary practice location

3910 Caughey Rd Ste 130
Erie, PA 16506

Mailing address

3910 Caughey Rd Ste 130
Erie, PA 16506-4097
Phone (814) 833-3668

Other practice location 1

1444 W 38th St
Suite A
Erie, PA 16508-2346
Phone (814) 866-5141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050412001174 PA Part B Supplier - Clinic/Group Practice 4587601489 Receives reassigned benefits from 1 practitioner
Practice locations: Edinboro, PA; Erie, PA
O20100930016317 PA DME Supplier - Physician - Podiatry 4587601489 Practice locations: Erie, PA

National Provider Directory

National Provider Directory

Locations

142 E 2ND St
Erie, PA 16507

1444 W 38th St
Erie, PA 16508
Phone (814) 835-7043

1444 W 38th St
Ste A
Erie, PA 16508
Phone (814) 866-5141

3910 Caughey Rd
Ste 130
Erie, PA 16506

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 11

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": "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • 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.