ACUSTEP DIABETIC FOOT CENTER, LLC (NPI# 1861630113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861630113 |
| Entity Type | Organization |
| Organization Name | ACUSTEP DIABETIC FOOT CENTER, LLC |
| Practice Address |
2139 W Republic Rd Springfield MO 65807-5705 |
| Practice Telephone | 4174473672 |
| Practice Fax Number | 4179872027 |
| Mailing Telephone | 4174473672 |
| Mailing Fax Number | 4179872027 |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2010-04-06 |
| Authorized Official Name | DR. JERYL G FULLEN (PRESIDENT) |
| Authorized Official Telephone | 7858260184 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | R5165 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MEDICARE | CLIA 2601105100 | 01 |
| MO | MEDICARE PTAN | MA1962001 | 01 |
| Street Address |
2139 W REPUBLIC RD |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65807-5705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396390241 | Karley Kassandra Murphy | Counselor | 3734 South Ave #c, Springfield, MO 65807 | 2019-08-07 |
| 1396203626 | Auvia L Logan | Dietitian, Registered | 3322 S. Campbell Ave. Suite Cc, Springfield, MO 65807 | 2019-03-05 |
| 1598250961 | Kathryn Barber | Nurse Practitioner | 3800 S National Ave Ste 700, Springfield, MO 65807 | 2018-06-27 |
| 1447764899 | Missouri Midwifery Service | Clinic/Center | 3840 South Avenue, Springfield, MO 65807 | 2017-11-21 |
| 1124530290 | Senior Living Management Group, LLC | Skilled Nursing Facility | 3705 S Jefferson Ave, Springfield, MO 65807 | 2017-10-30 |
| 1740663335 | Sarah E Kirk | Physical Therapist | 3545 S. National Ave, Springfield, MO 65807 | 2015-07-01 |
| 1750713335 | Amanda Ward | Nurse Practitioner | 2150 W Republic Rd Ste 112, Springfield, MO 65807 | 2013-08-06 |
| 1932531126 | Eugenia R Cortez | Counselor | 2124 Chesterfield Blvd., Springfield, MO 65807 | 2013-07-30 |
| 1962742866 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3045 W Republic St, Springfield, MO 65807 | 2013-03-01 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| Find all providers in zip 65807 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104440049 | Elliot M Johns | Orthopaedic Surgery | 301 N 8th St Ste 3a158, Springfield, IL 62701-1085 | 2020-06-06 |
| 1740804764 | David Alan Forgas | Orthopaedic Surgery | 901 N 1st St # D252, Springfield, IL 62702-3759 | 2020-06-05 |
| 1063849719 | Effingham Hospital, Inc. | Orthopaedic Surgery | 459 Highway 119 S Ste A, Springfield, GA 31329-3021 | 2013-09-26 |
| 1851646566 | Kenneth David Illingworth | Orthopaedic Surgery | 301 N 8th St Pav 3a158, Springfield, IL 62794 | 2012-07-18 |
| 1760792329 | Lasante Inc | Orthopaedic Surgery | 4936 Laverna Road, Springfield, IL 62707-9797 | 2010-10-18 |
| 1902134638 | Optim Orthopedics, LLC | Orthopaedic Surgery | 459 Highway 119 South, Springfield, GA 31329 | 2009-11-18 |
| 1902066491 | Charles Joseph Ash | Orthopaedic Surgery | 3433 I S Campbell, Springfield, MO 65807 | 2008-06-10 |
| 1366616849 | Jennie Garver | Orthopaedic Surgery | 300 Birnie Ave Ste 301, Springfield, MA 01107 | 2008-04-16 |
| 1841487733 | Maplegate Rehab Inc. Dba Medical Associates | Orthopaedic Surgery | 181 State St, Springfield, MA 01103-1719 | 2007-09-25 |
| 1669681003 | Samuel A Finck | Orthopaedic Surgery | 2600 N Limestone St Ste 150, Springfield, OH 45503 | 2007-05-22 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65807 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.