Individual provider Active NPI

Joel E Schancupp

  • Podiatrist
  • Roswell, GA
National Provider Identifier
1972584498
Registry record updated Feb 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
POD 000506 Issued in GA
Practice address
1030 Woodstock Rd
Ste 3106
Roswell, GA 30075-8271
Phone
(770) 993-0880
Fax
(770) 993-9722
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X POD 000506 GA Primary

Addresses

Primary practice location

1030 Woodstock Rd
Ste 3106
Roswell, GA 30075-8271

Mailing address

1030 Woodstock Rd
Ste 3106
Roswell, GA 30075-8271
Phone (770) 993-0880

Other identifiers 1

IdentifierTypeStateIssuer
00263062AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080112000041 GA Practitioner - Podiatry 6709832504 Practice locations: Roswell, GA
O20100930082311 GA DME Supplier - Physician - Podiatry 2961523790 Practice locations: Roswell, GA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1030 Woodstock Rd
Roswell, GA 30075-8271
Phone (770) 993-0880

Hospital & facility affiliations

  • Northside Hospital Hospital, Atlanta, GA, CCN 110161

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue15
Removal of skin lesions28
Removal of nail tissue253
Removal or shaving of skin growth45
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
506GAMDPsychologist
POD 000506GAMDPodiatrist

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738368000000",
    "number": "1972584498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 WOODSTOCK RD",
            "address_2": "STE 3106",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300758271",
            "telephone_number": "770-993-0880",
            "fax_number": "770-993-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 WOODSTOCK RD",
            "address_2": "STE 3106",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300758271",
            "telephone_number": "770-993-0880",
            "fax_number": "770-993-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHANCUPP",
        "first_name": "JOEL",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2025-02-01",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD 000506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00263062A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.