NPIMap

Organization Active NPI

Charlotte Limb Preservation & Diabetic Foot Center PLLC

  • Foot & Ankle Surgery Podiatrist
  • Charlotte, NC
National Provider Identifier
1932856333
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
CHARLOTTE LIMB PRESERVATION & DIABETIC FOOT CENTER PLLC
Practice address
10035 Park Cedar Dr Ste 100
Charlotte, NC 28210-8910
Phone
(917) 841-3619
NPI assigned
Mar 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Authorized official

Name
David Jason Ellenbogen, DPM, FACFASNPI 1831222090
Title
President
Phone
(704) 442-9011

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213EP1101X
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X Primary
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X

Addresses

Primary practice location

10035 Park Cedar Dr Ste 100
Charlotte, NC 28210-8910

Mailing address

2504 Whitney Hill Rd
Charlotte, NC 28226-4341
Phone (917) 841-3619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220621000961 NC Part B Supplier - Clinic/Group Practice 2365821469 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC
O20220810001369 NC DME Supplier - Physician - Podiatry 2365821469 Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Limb Preservation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1932856333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 WHITNEY HILL RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282264341",
            "telephone_number": "917-841-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10035 PARK CEDAR DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108910",
            "telephone_number": "917-841-3619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE LIMB PRESERVATION & DIABETIC FOOT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-04",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "ELLENBOGEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-442-9011",
        "authorized_official_credential": "DPM, FACFAS"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.