ELLSWORTH FOOT AND ANKLE — NPI 1003567926 (Licensed & Credentialed Podiatric Medicine & Surgery Service Providers

CMS-1500 Box 24J / 33a • NPI

1003567926

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

213E00000X (CMS 48)

Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist

Box 32 Service Location & ZIP+4

95 WHITE SAGE AVE, DELTA, UT, 84624-5555

✓ 9-Digit EDI 837 ZIP+4 (84624-5555)

Practice Phone & Referral Fax

(801) 253-6886

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1003567926 (ELLSWORTH FOOT AND ANKLE) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1003567926` (NPI-2 Organization / Facility)
Provider / Legal Name	ELLSWORTH FOOT AND ANKLE
Plain-English Specialty	Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist NUCC Code: `213E00000X` (Podiatrist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	95 WHITE SAGE AVE, DELTA, UT, 84624-5555
Practice Telephone / Fax	Tel: (801) 253-6886
Administrative Mailing Address	9980 S 300 W STE 310, SANDY, UT, 84070-3654
Enumeration & Last Sync	Enumerated: 2022-01-12 \| CMS Record Updated: 2022-01-12
Authorized Official	ALLISON PECK (Credentialing Specialist)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

95 WHITE SAGE AVE, DELTA, UT, 84624-5555

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Plain-English Taxonomy & CMS Crosswalk (213E00000X)

What Does Taxonomy Code 213E00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 213E00000X translates to:
"Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 48 (Podiatry)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Podiatrist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ELLSWORTH FOOT AND ANKLE)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`213E00000X` — Podiatrist Plain English: Licensed & Credentialed Podiatric Medicine & Surgery Service Providers — Podiatrist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ELLSWORTH FOOT AND ANKLE (NPI #1003567926)