Organization Active NPI

Advanced Foot Specialists, PLLC

  • Foot & Ankle Surgery Podiatrist
  • Rockwall, TX
National Provider Identifier
1104233675
Registry record updated Jan 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
2086 Issued in TX
Legal business name
ADVANCED FOOT SPECIALISTS, PLLC
Practice address
201 E Interstate 30
Suite B
Rockwall, TX 75087-5402
Phone
(214) 771-3668
Fax
(972) 774-0066
NPI assigned
Jul 16, 2014
Last updated
Jan 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2016

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

Authorized official

Name
Benjamin A Bassichis, MD
Title
Owner
Phone
(214) 394-8645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 2086 TX Primary

Addresses

Primary practice location

201 E Interstate 30
Suite B
Rockwall, TX 75087-5402

Mailing address

4515 Dorset Rd
Dallas, TX 75229-6301
Phone (214) 394-8645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150302001112 TX Part B Supplier - Clinic/Group Practice 9739306499 Receives reassigned benefits from 4 practitioners
Practice locations: Dallas, TX; Greenville, TX; Rockwall, TX; Sachse, TX
O20160504000841 TX DME Supplier - Physician - Podiatry 9739306499 Practice locations: Rockwall, TX

National Provider Directory

National Provider Directory

Locations

3600 Gaston Ave
Ste 405
Dallas, TX 75246

201 E Interstate 30
Rockwall, TX 75087
Phone (214) 771-3668

201 E Interstate 30
Ste B201
Rockwall, TX 75087

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451865600000",
    "number": "1104233675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 DORSET RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752296301",
            "telephone_number": "214-394-8645",
            "fax_number": "972-774-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E INTERSTATE 30",
            "address_2": "SUITE B",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875402",
            "telephone_number": "214-771-3668",
            "fax_number": "972-774-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FOOT SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2016-01-04",
        "status": "A",
        "authorized_official_last_name": "BASSICHIS",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-394-8645",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "2086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.