RUSSELL A. GROOTEGOED DPM NPI 1194767921

NPI Information

NPI: 1194767921
Provider Name: RUSSELL A. GROOTEGOED, DPM
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

Address:
601 W 9TH ST
SAN PEDRO, CA
ZIP 90731
Phone: (310) 833-3583
Get Directions

Russell A. Grootegoed, DPM is a foot and ankle surgery podiatrist in San Pedro, CA. Russell A. Grootegoed, DPM NPI is 1194767921. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

601 W 9TH ST
SAN PEDRO, CA
ZIP 90731-107
Phone: (310) 833-3583
Fax: (310) 833-1976

The enumeration date for this NPI number is 6/13/2006 and was last updated on 4/11/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	335E00000X	Prosthetic/Orthotic Supplier		E2064	CALIFORNIA	No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	E2064	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	953239247	OTHER	CALIFORNIA	BLUE CROSS
2	T11163	MEDICARE UPIN	CALIFORNIA
3	3899650001	MEDICARE NSC	CALIFORNIA
4	E2064	MEDICARE PIN	CALIFORNIA
5	000E2064000	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »