21 NCAC 52 .0207             ANNUAL RENEWAL OF LICENSE

(a)  The executive secretary of the board shall mail to the last known address of each license holder each year a form on which to apply for renewal of his or her license. The renewal application shall be pre-populated with information contained in the board's licensee database with a space for corrections or additions with regard to the following information about the licensee:

(1)           Social security number;

(2)           National Provider Number (NPI), if any;

(3)           Drug Enforcement Administration License Number (DEA), if any;

(4)           Marital status;

(5)           Name;

(6)           NC license number;

(7)           Birthdate;

(8)           Other states licensed in and license numbers;

(9)           Home address and phone number;

(10)         Business address and phone number;

(11)         Preferred mailing address (business or home);

(12)         Email address:

(13)         Whether or not the licensee would like to receive email correspondence from the board;

(14)         Medicare provider number;

(15)         Present practice status (e.g., active, teaching, retired, residency, other);

(16)         Principal setting of practice (e.g., hospital, nursing home, free-standing clinic, group, practitioner's office, nonfederal health facility, military facility, Veteran's Administration medical facility, school, other);

(17)         Form of employment (e.g., self-employed as a solo practitioner or non-solo practitioner, or employee of individual practitioner, partnership or group, government, other);

(18)         National board certifications (American Board of Podiatric Surgery, American Board of Foot and Ankle Surgery, American Board of Lower Extremity Surgery, and American Board of Multiple Specialties in Podiatry);

(19)         Hospital staff privileges (hospital, location, date privileges began, type of privileges), any denial of such privileges, and the reason for such denial since last renewal application;

(20)         Whether or not the licensee performs amputations, ankle surgery, or clubfoot procedures;

(21)         Whether or not the licensee is granted specialty privileges by the board for amputations, ankle surgery, or clubfoot procedures;

(22)         Continuing Medical Education (CME) credits earned in the previous license year, pursuant to G.S. 90-202.11 and S.L. 2015-241, s. 12F, 16(c);

(23)         Whether or not the licensee has ever had a license revoked, suspended, denied, or cancelled; been a defendant in a legal action involving professional liability (malpractice), been named in a malpractice suit, had a professional liability claim paid on the applicant's behalf or paid such a claim; been a patient for the treatment of mental illness; been addicted to drugs or alcohol; or been convicted of a felony; and any explanation regarding such information that the applicant wishes to present to the board;

(24)         Original signature;

(25)         Date of renewal application; or

(26)         Desire not to renew license.

(b)  The renewal form and accompanying documents shall be returned to the board's offices as set forth in Rule .0101 with the original signatures of the licensed podiatrist. The penalties for failure to comply with this Rule are specified in G.S. 90‑202.10.

(c)  If the licensee does not receive his or her renewal application from the board directly, the licensee may obtain a generic copy, without the pre-populated information, from the board's website at http://www.ncbpe.org or by contacting the board's office as set forth in Rule .0101 of this Chapter.

History Note:        Authority G.S. 90‑202.4(g); 90‑202.10; 90-202.11; S.L. 2015-241, s. 12F, 16(c);

Eff. February 1, 1976;

Amended Eff. April 1, 2013; January 1, 2005; December 1, 1988;

Readopted Eff. September 1, 2016;

Amended Eff. May 1, 2017.