PROACTIVE FOOT AND ANKLE – Foot & Ankle Surgery Podiatrist, NPI 1639699325
Foot & Ankle Surgery Podiatrist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PROACTIVE FOOT AND ANKLE
215 Old Tappan Rd
Old Tappan, NJ 076757000
Phone: (201) 930-9090
Type: Location
74 PASCACK RD STE 6
PARK RIDGE, NJ 076561942
Phone: (201) 391-1113
Type: Location
64 Fairview Ave
Westwood, NJ 076752241
Phone: (201) 664-5115
Type: Location
322 Kinderkamack Rd
Westwood, NJ 076751635
Phone: (201) 666-5115
Type: Location
297 Kinderkamack Rd
Oradell, NJ 076491538
Phone: (201) 261-7407
Type: Location
466 Old Hook Rd Ste 24D
Emerson, NJ 076301368
Phone: (201) 261-0500
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-01-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-04-30 (771 days ago).
Enrollment records
1
Earliest due date
2024-04-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20180108002538 | O | Clinic/Group Practice | NJ | 2024-04-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 07675)
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