Individual provider Active NPI

Richard Raymond Bruno, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Suffolk, VA
National Provider Identifier
1013440569
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0103301288 Issued in VA
Practice address
2790 Godwin Blvd Ste 355
Suffolk, VA 23434-8173
Phone
(757) 983-8520
Fax
(757) 579-8646
NPI assigned
Apr 11, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 0103301288 VA Primary

Addresses

Primary practice location

2790 Godwin Blvd Ste 355
Suffolk, VA 23434-8173

Mailing address

2790 Godwin Blvd Ste 355
Suffolk, VA 23434-8173
Phone (757) 983-8520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200522002494 VA Practitioner - Podiatry 1557636388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

2790 Godwin Blvd
Suite 355
Suffolk, VA 23434-8173
Phone (757) 983-8520

Hospital & facility affiliations

  • Sentara Home Care Services-Suffolk Home health agency, Suffolk, VA, CCN 497746
  • Sentara Obici Hospital Hospital, Suffolk, VA, CCN 490044

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue66
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Podiatrist CurrentSince Jul 1, 2020 Accepting new patients

Locations

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

2790 Godwin Blvd
Ste 355
Suffolk, VA 23434
Phone (757) 635-0784

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1013440569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD STE 355",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348173",
            "telephone_number": "757-983-8520",
            "fax_number": "757-579-8646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD STE 355",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348173",
            "telephone_number": "757-983-8520",
            "fax_number": "757-579-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNO",
        "first_name": "RICHARD",
        "middle_name": "RAYMOND",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-11",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103301288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.