Stanley Idiculla, DPM

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

XXXX Issued in VA

Practice address

112 Elden St
Suite D
Herndon, VA 20170-4874

Phone

(703) 437-5353

NPI assigned

Apr 13, 2006

Last updated

Dec 18, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nova Foot and Ankle PLLCGroup PAC ID 2860630613, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8239/brand/1/csg/1/fhir/r4
• Direct secure messaging: stanley.idiculla.1@8239.direct.athenahealth.com

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

• Nova Foot and Ankle PLLC

  • Foot & Ankle Surgery Podiatrist
  • Herndon, VA
  • NPI 1770828527

  DC, Foot Surgery

  Medicare reassignment Care Compare group NPD
• Nova Foot and Ankle PLLC

  • Foot & Ankle Surgery Podiatrist
  • Springfield, VA
  • NPI 1629428750

  Foot Surgery

  NPD

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1043274368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 ELDEN ST",
            "address_2": "SUITE D",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704874",
            "telephone_number": "703-437-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 ELDEN ST",
            "address_2": "SUITE D",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704874",
            "telephone_number": "703-437-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULLA",
        "first_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "VA",
            "license": "XXXX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William B Hutcheson, OD
• Steven Van Huynh, PT, DPT
• Monica Luu Quach Hwang, M.D.
• Hysa Cognitive and Neurorehabilitation PLLC
• Hyuksoo Kwon, DDS, PC
• Zarmina Ifzal, DMD
• Shamim Akhtar Imam, M.D.
• Imran Akram MD PC
• William A Incatasciato, MD
• Eric Aaron Ingold, DPT

• Foot Surgery Podiatrist in Herndon, VA
• Providers in Herndon, VA by specialty
• Foot Surgery Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.