Prime Podiatric Group, Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

PRIME PODIATRIC GROUP, INC

Practice address

10916 Riverside Dr
Toluca Lake, CA 91602-2210

Phone

(818) 488-6076

Fax

(818) 210-0281

NPI assigned

Feb 2, 2024

Organization subpart

No

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

Authorized official

Name

Jonathan Jay Pirak, DPMNPI 1528598133

Title

Ceo/Owner

Phone

(818) 488-6076

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

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

• Jonathan Pirak, DPM

  • Podiatrist
  • Los Angeles, CA
  • NPI 1528598133

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Nina C. Robinson, DPM

  • Foot Surgery Podiatrist
  • Beverly Hills, CA
  • NPI 1477696078
  Medicare reassignment Care Compare group NPD
• Dwight Gregory Stephens, DPM

  • Podiatrist
  • Inglewood, CA
  • NPI 1053334813
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1962265835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10916 RIVERSIDE DR",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022210",
            "telephone_number": "818-488-6076",
            "fax_number": "818-210-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10916 RIVERSIDE DR",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022210",
            "telephone_number": "818-488-6076",
            "fax_number": "818-210-0281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PODIATRIC GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-02",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "PIRAK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "818-488-6076",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Toluca Lake, CA
• Providers in Toluca Lake, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.