CASEY FILLERUP DPM, NPI 1093229650 — LOS ANGELES (CA)

NPI 1093229650

2+ Years Experience Individual

CASEY FILLERUP DPM

11/18/2017
PROVIDER ENUMERATION DATE
03/17/2018
LAST UPDATE DATE
1093229650
NPI NUMBER

About CASEY FILLERUP

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

CASEY FILLERUP is a provider established in LOS ANGELES, CA. The NPI number of CASEY FILLERUP is 1093229650 and was assigned on 11/18/2017. The practitioners primary taxonomy code is: 213E00000X with license number: 6848 CA .

Mailing address

  • City: ARROYO GRANDE
  • State: CA
  • Postal code: 934205167
  • Address: 929 BUCK RIDGE LN

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1093229650
  • Phone : 3232685000
  • Postalcode : 900332414
  • Address : 1720 E CESAR E CHAVEZ AVE

Provider taxonomy - Podiatrist

  • Taxonomy code: 213E00000X
  • License number: 6848
  • License state: CA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy group: 193200000X MULTI-SPECIALTY GROUP.

Taxonomy description: A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Contacts:

Click to Show Map
  • CASEY FILLERUP DPM
  • Address : 1720 E CESAR E CHAVEZ AVE
  • Region : LOS ANGELES, CA
  • NPI : 1093229650
  • Phone : 3232685000
  • Postalcode : 900332414

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1720 E CESAR E CHAVEZ AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900332414
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3232685000
The telephone number associated with the location address of the provider being identified.
NPI1093229650
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1213E00000X
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
Provider Enumeration Date11/18/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated03/17/2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)CASEY FILLERUP
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address929 BUCK RIDGE LN
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameARROYO GRANDE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code934205167
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Healthcare Provider Taxonomy Code #1213E00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Podiatrist
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
Provider License Number 16848
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1CA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

Share this page?