Russell Pendleton, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

1916 Issued in TX

Practice address

6312 Azle Ave
Lake Worth, TX 76135-2442

Phone

(817) 238-8400

Fax

(817) 238-8401

NPI assigned

Aug 23, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Foot and Ankle Associates PLLCGroup PAC ID 7113050758, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Harris Methodist Hospital Azle Hospital, Azle, TX, CCN 450419
• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Advanced Foot and Ankle Associates PLLC

  • Foot & Ankle Surgery Podiatrist
  • Lake Worth, TX
  • NPI 1568783553
  Medicare reassignment Care Compare group NPD Authorized official
• Advanced Foot and Ankle Associates PLLC

  • Foot & Ankle Surgery Podiatrist
  • Saginaw, TX
  • NPI 1851602858
  NPD Authorized official
• Podiatry Consultants of Texas, Inc

  • Podiatrist
  • Katy, TX
  • NPI 1831147990
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Texas Health Harris Methodist Hospital Azle

  • General Acute Care Hospital
  • Azle, TX
  • NPI 1508899204
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation

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

{
    "created_epoch": "1219449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1932356789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6312 AZLE AVE",
            "city": "LAKE WORTH",
            "state": "TX",
            "postal_code": "761352442",
            "telephone_number": "817-238-8400",
            "fax_number": "817-238-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6312 AZLE AVE",
            "city": "LAKE WORTH",
            "state": "TX",
            "postal_code": "761352442",
            "telephone_number": "817-238-8400",
            "fax_number": "817-238-8401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Crown Pointe Blvd Ste 240",
            "address_purpose": "LOCATION",
            "city": "Willow Park",
            "state": "TX",
            "postal_code": "760871192",
            "country_code": "US",
            "telephone_number": "817-400-2004",
            "fax_number": "888-843-5379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-23",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "1916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214330702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214330704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Lake Worth, TX
• Providers in Lake Worth, TX by specialty
• Foot & Ankle Surgery Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.