Current through Register Vol. 38, No. 18, March 15, 2024
(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.
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.