BLUE WATER PODIATRY PC — NPI 1447397138 (Licensed & Credentialed Podiatric Medicine & Surgery Service Providers

CMS-1500 Box 24J / 33a • NPI

1447397138

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

1060 S VAN DYKE RD, SUITE 100, BAD AXE, MI, 48413-9631

✓ 9-Digit EDI 837 ZIP+4 (48413-9631)

Practice Phone & Referral Fax

(989) 269-9575

Fax: (989) 269-9576

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1447397138 (BLUE WATER PODIATRY PC) 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	`1447397138` (NPI-2 Organization / Facility)
Provider / Legal Name	BLUE WATER PODIATRY PC
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	1060 S VAN DYKE RD, SUITE 100, BAD AXE, MI, 48413-9631
Practice Telephone / Fax	Tel: (989) 269-9575 \| Fax: (989) 269-9576
Administrative Mailing Address	5303 SHOREWOOD DR, FORT GRATIOT, MI, 48059-3137
Enumeration & Last Sync	Enumerated: 2007-01-31 \| CMS Record Updated: 2010-01-20
Authorized Official	THOMAS ERNST (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1060 S VAN DYKE RD, SUITE 100, BAD AXE, MI, 48413-9631

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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 (BLUE WATER PODIATRY PC)

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: MI \| License: `59000955` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BLUE WATER PODIATRY PC (NPI #1447397138)