Individual provider Active NPI

Eideh D. Atway, D.P.M.

  • Podiatrist
  • Grapevine, TX
National Provider Identifier
1922367663
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2012 Issued in TX
Practice address
1245 Falcon Dr
Grapevine, TX 76051-1117
Phone
(805) 836-2867
Fax
(214) 540-8547
NPI assigned
May 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 2012 TX Primary

Addresses

Primary practice location

1245 Falcon Dr
Grapevine, TX 76051-1117

Mailing address

1245 Falcon Dr
Grapevine, TX 76051-1117
Phone (805) 836-2867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120716000286 TX Practitioner - Podiatry 1153587365 Reassigns benefits to 2 organizations
I20120720000213 PA Practitioner - Podiatry 1153587365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1245 Falcon Dr
Grapevine, TX 76051-1117
Phone (805) 836-2867

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue427
Removal of nail tissue582
Removal or shaving of skin growth425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012TXMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Guardian Biologics LLC CurrentSince Dec 3, 2023 Accepting new patients
Back Office Management Services LLC Podiatrist CurrentSince May 15, 2012 Accepting new patients
Deformity Reconstruction Specialists PLLC Podiatrist CurrentSince Dec 12, 2016 Accepting new patients
Back Office Management Services LLC Podiatrist CurrentSince May 15, 2012 Accepting new patients
Back Office Management Services LLC Podiatrist CurrentSince Jun 20, 2012 Accepting new patients

Locations

820 Durham Rd
Newtown, PA 18940
Phone (215) 589-7181

500 W Hospital St
Taylor, PA 18517
Phone (570) 483-8450

2100 W Colorado Blvd
Dallas, TX 75211
Phone (214) 865-9968

210 W Wall St
Grapevine, TX 76051
Phone (757) 354-6641

434 Paza Dr
Mesquite, TX 75149
Phone (972) 286-6489

4200 Shepherd Ln
Mesquite, TX 75180
Phone (972) 286-0335

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1922367663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 FALCON DR",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760511117",
            "telephone_number": "805-836-2867",
            "fax_number": "214-540-8547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 FALCON DR",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760511117",
            "telephone_number": "805-836-2867",
            "fax_number": "214-540-8547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATWAY",
        "first_name": "EIDEH",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-15",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "2012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.