Russell Olin Pendleton (NPI# 1932356789, PAC ID# 8022141662) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PODIATRY.
Nation Provider ID (NPI) | 1932356789 |
PAC ID by PECOS | 8022141662 |
Professional Enrollment ID | I20100803000201 |
Full Name | Russell Olin Pendleton |
Organization Legal Name | ADVANCED FOOT AND ANKLE ASSOCIATES |
Address |
6312 Azle Ave Lake Worth TX 76135-2442 |
Phone Number | 8172388400 |
Gender | M |
Medical School | DR. WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE |
Graduation Year | 2007 |
Primary Specialty | PODIATRY |
Group Practice PAC ID | 7113050758 |
Number of Group Practice Members | 2 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
450419 | TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE |
450135 | TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH |
Address | Phone | Organization |
---|---|---|
6312 Azle Ave, Lake Worth, TX 76135-2442 | 8172388400 | ADVANCED FOOT AND ANKLE ASSOCIATES |
Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
---|---|---|---|
MIPS_EC_126_overall | Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation | 31% |
Organization Legal Name | ADVANCED FOOT AND ANKLE ASSOCIATES |
Physicians | 2 |
Name | Specialty | Organization | Address |
---|---|---|---|
Mary Caroline Stancukas | Podiatry | Advanced Foot and Ankle Associates | 6312 Azle Ave, Lake Worth, TX 76135-2442 |
Street Address |
6312 AZLE AVE |
City | LAKE WORTH |
State | TX |
Zip | 76135-2442 |
Name | Specialty | Organization | Address |
---|---|---|---|
Mary Caroline Stancukas | Podiatry | Advanced Foot and Ankle Associates | 6312 Azle Ave, Lake Worth, TX 76135-2442 |
Name | Specialty | Organization | Address |
---|---|---|---|
Tamara K Hanby | Family Medicine | 6302 A Jackson Hwy, Fort Worth, TX 76135 | |
Max S Hughes | Family Medicine | 6302a Jacksboro Hwy, Fort Worth, TX 76135 | |
Gary W Sanders | Chiropractic | 4712 Boat Club Rd, Fort Worth, TX 76135-2002 | |
Andrea N Lowe | Clinical Social Worker | The Oaks Life Center Pllc | 6012 Reef Point Ln, Suite C, Fort Worth, TX 76135-2056 |
Heather Braun | Clinical Social Worker | The Oaks Life Center Pllc | 6012 Reef Point Ln, Suite C, Fort Worth, TX 76135-2056 |
Debra P Mattocks | Clinical Social Worker | The Oaks Life Center Pllc | 6012 Reef Point Ln, Suite C, Fort Worth, TX 76135-2056 |
Kasey Shaw | Clinical Social Worker | The Oaks Life Center Pllc | 6012 Reef Point Ln, Suite C, Fort Worth, TX 76135-2056 |
Yolanda M Fraser | Clinical Social Worker | The Oaks Life Center Pllc | 6012 Reef Point Ln, Suite C, Fort Worth, TX 76135-2056 |
Katrina R Lieske | Optometry | 6060 Azle Ave, Suite 500, Lake Worth, TX 76135-2612 | |
Jeffrey R Crabtree | Optometry | 6921 Foster Dr, Lake Worth, TX 76135-2818 | |
Find all physicians in zip 76135 |
City | LAKE WORTH |
Zip Code | 76135 |
Specialty | PODIATRY |
City + Specialty | LAKE WORTH + PODIATRY |
Please comment or provide details below to improve the information on Russell Olin Pendleton.
Data Provider | Centers for Medicare & Medicaid Services (CMS) |
Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.