Village Podiatry Group, LLC.
Organization Active NPI Podiatrist · Lawrenceville, GA
NPI 1992898167 · NPPES record last updated Nov 28, 2011
Key facts
- NPI
- 1992898167
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- VILLAGE PODIATRY GROUP, LLC.
- Practice address
- 500 Medical Center Blvd
Suite 100
Lawrenceville, GA 30046-8708 - Phone
- (770) 822-2166
- Fax
- (770) 237-2934
- NPI assigned
- Oct 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- EXTREMITY HEALTHCARE, INC.
Authorized official
- Name
- David N. Helfman, DPM
- Title
- Ceo
- Phone
- (770) 384-0284
Corporate family (same tax ID) 34
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930075350 | GA | DME Supplier - Physician - Podiatry | 4587646971 | Practice locations: Lawrenceville, GA |
National Provider Directory
- Tax ID family
- Village Podiatry Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
500 Medical Center Blvd
Suite 100
Lawrenceville, GA 30046-8708
Mailing address
900 Circle 75 Pkwy.
Ste. 900
Atlanta, GA 30339-3084
Phone (770) 384-0284
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CL1536 | Other | GA | RAILROAD MEDICARE GRP NBR |
NPI Registry JSON
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1322438400000",
"number": "1992898167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 CIRCLE 75 PKWY.",
"address_2": "STE. 900",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303393084",
"telephone_number": "770-384-0284",
"fax_number": "770-432-7638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 MEDICAL CENTER BLVD",
"address_2": "SUITE 100",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468708",
"telephone_number": "770-822-2166",
"fax_number": "770-237-2934"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VILLAGE PODIATRY GROUP, LLC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EXTREMITY HEALTHCARE, INC.",
"enumeration_date": "2006-10-02",
"last_updated": "2011-11-28",
"status": "A",
"authorized_official_last_name": "HELFMAN",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "N.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "770-384-0284",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GRP NBR",
"identifier": "CL1536",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.