NPIMap

Organization Active NPI

South Jersey Foot & Ankle Centers

  • Foot & Ankle Surgery Podiatrist
  • Collingswood, NJ
National Provider Identifier
1952494510
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
25MD00145200 Issued in NJ
Legal business name
SOUTH JERSEY FOOT & ANKLE CENTERS
Practice address
570 Haddon Ave
Collingswood, NJ 08108-1449
Phone
(856) 854-3093
Fax
(856) 854-7969
NPI assigned
Oct 2, 2006
Last updated
Oct 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Authorized official

Name
Dr. David Charles Kraatz, DPM
Title
President
Phone
(856) 854-3093

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 25MD00145200 NJ Primary

Addresses

Primary practice location

570 Haddon Ave
Collingswood, NJ 08108-1449

Mailing address

570 Haddon Ave
Collingswood, NJ 08108-1449
Phone (856) 854-3093

Other identifiers 7

IdentifierTypeStateIssuer
7771100MedicaidNJ
25032OtherNJAETNA
1012298OtherNJHORIZON MERCY
01000445700OtherNJAMERICHOICE
CG7953OtherNJRAILROAD MEDICARE
3K4669OtherNJHEALTH NET
0072427000OtherNJAMERIHEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050321000168 NJ Part B Supplier - Clinic/Group Practice 8123073426 Receives reassigned benefits from 4 practitioners
Practice locations: Cinnaminson, NJ; Riverside, NJ

National Provider Directory

National Provider Directory

Locations

570 Haddon Ave
Ste C
Haddon Township, NJ 08108
Phone (856) 833-1479

135 Bridgeboro St
Riverside, NJ 08075
Phone (800) 626-0990

Practitioners & affiliated clinicians

Practitioners 8

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1952494510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 HADDON AVE",
            "city": "COLLINGSWOOD",
            "state": "NJ",
            "postal_code": "081081449",
            "telephone_number": "856-854-3093",
            "fax_number": "856-854-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 HADDON AVE",
            "city": "COLLINGSWOOD",
            "state": "NJ",
            "postal_code": "081081449",
            "telephone_number": "856-854-3093",
            "fax_number": "856-854-7969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY FOOT & ANKLE CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "KRAATZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-854-3093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00145200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7771100",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "25032",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON MERCY",
            "identifier": "1012298",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "01000445700",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG7953",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "3K4669",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0072427000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collingswood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.