NPIMap

Organization Active NPI

Alderwood Ankle & Foot Clinic P.S.

Doing business as Lake Stevens Ankle and Foot Clinic

  • Foot & Ankle Surgery Podiatrist
  • Lake Stevens, WA
National Provider Identifier
1942967393
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
ALDERWOOD ANKLE & FOOT CLINIC P.S.
Doing business as
Lake Stevens Ankle and Foot Clinic
Practice address
9514 4TH St NE Unit 201
Lake Stevens, WA 98258-1937
Phone
(425) 397-7401
Fax
(425) 397-7627
NPI assigned
Nov 19, 2021
Last updated
Jan 19, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ALDERWOOD ANKLE AND FOOT CLINIC, P.S.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Authorized official

Name
Sophina Y Nunez
Title
Vice President
Phone
(425) 778-5666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

9514 4TH St NE Unit 201
Lake Stevens, WA 98258-1937

Mailing address

9514 4TH St NE Unit 201
Lake Stevens, WA 98258-1937
Phone (425) 397-7401

Other names 1

  • Lake Stevens Ankle and Foot Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sophina-n@direct.practicefusion.com Health Information Exchange (HIE) Alderwood Ankle & Foot Clinic P.S.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319001458 WA Part B Supplier - Clinic/Group Practice 5698665784 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lynnwood, WA; Lake Stevens, WA
O20220316000877 WA DME Supplier - Physician - Podiatry 5698665784 Practice locations: Lake Stevens, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Alderwood Ankle Foot Clini

Locations

9514 4th St NE
Unit 201
Lake Stevens, WA 98258
Phone (425) 397-7401

18631 Alderwood Mall Pkwy
Ste 204
Lynnwood, WA 98037
Phone (425) 778-5666

3500 188th St SW
Ste 110
Lynnwood, WA 98037
Phone (425) 778-5666

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1942967393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9514 4TH ST NE UNIT 201",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982581937",
            "telephone_number": "425-397-7401",
            "fax_number": "425-397-7627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9514 4TH ST NE UNIT 201",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982581937",
            "telephone_number": "425-397-7401",
            "fax_number": "425-397-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALDERWOOD ANKLE & FOOT CLINIC P.S.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALDERWOOD ANKLE AND FOOT CLINIC, P.S.",
        "enumeration_date": "2021-11-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "NUNEZ",
        "authorized_official_first_name": "SOPHINA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "425-778-5666"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sophina-n@direct.practicefusion.com",
            "affiliation": "Y",
            "affiliationName": "Alderwood Ankle & Foot Clinic P.S.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3500 188th St SW Ste 110",
            "city": "Lynnwood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980374757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lake Stevens Ankle and Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Stevens, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.