NPIMap

Organization Active NPI

Foot Doc PLLC

  • Primary Podiatric Medicine Podiatrist
  • Chandler, AZ
National Provider Identifier
1952923708
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
Legal business name
FOOT DOC PLLC
Practice address
955 N McQueen Rd Ste 1
Chandler, AZ 85225-8129
Phone
(480) 744-6234
Fax
(480) 907-0500
NPI assigned
May 15, 2020
Last updated
Dec 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

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

Authorized official

Name
Dr. Steven O'BryantNPI 1386050060
Title
Owner
Phone
(480) 744-6234

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 Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

955 N McQueen Rd Ste 1
Chandler, AZ 85225-8129

Mailing address

955 N McQueen Rd Ste 1
Chandler, AZ 85225-8129
Phone (480) 744-6234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200622000491 AZ Part B Supplier - Clinic/Group Practice 4789006792 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenix, AZ; Chandler, AZ
O20200731001359 AZ DME Supplier - Physician - Podiatry 4789006792 Practice locations: Chandler, AZ

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

955 N McQueen Rd
Chandler, AZ 85225

955 N McQueen Rd
Ste 150
Chandler, AZ 85225

Practitioners & affiliated clinicians

Practitioners 1

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": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1952923708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 N MCQUEEN RD STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852258129",
            "telephone_number": "480-744-6234",
            "fax_number": "480-907-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 N MCQUEEN RD STE 1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852258129",
            "telephone_number": "480-744-6234",
            "fax_number": "480-907-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT DOC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "O'BRYANT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-744-6234",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.