EASTSIDE FOOT AND ANKLE – Foot & Ankle Surgery Podiatrist, NPI 1669884003
Foot & Ankle Surgery Podiatrist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for EASTSIDE FOOT AND ANKLE
1717 NE 42ND AVE
SUITE 3300
PORTLAND, OR 972131569
Phone: (503) 284-2000
Fax: (503) 284-2002
Type: Mailing
12672 NW Barnes Rd Ste 100
Portland, OR 972296191
Phone: (503) 284-2000
Type: Location
24076 SE Stark St Ste 320
Gresham, OR 970303386
Phone: (503) 284-2000
Type: Location
1827 NE 44TH AVE STE 100
PORTLAND, OR 972131443
Phone: (503) 284-2000
Fax: (503) 284-2002
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2020-08-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1011 days ago).
Enrollment records
1
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20200821001236 | O | Physician - Podiatry | OR | 2023-08-31 |
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 97213)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.