NPIMap

Organization Active NPI

Manassas Foot Clinic PLLC

  • Foot & Ankle Surgery Podiatrist
  • Manassas, VA
National Provider Identifier
1184050650
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
MANASSAS FOOT CLINIC PLLC
Practice address
8704 Rolling Rd
Manassas, VA 20110-4253
Phone
(703) 361-3132
Fax
(703) 368-0291
NPI assigned
Sep 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Authorized official

Name
Dr. Ricardo M Bennett, DPMNPI 1134237449
Title
President
Phone
(703) 361-3132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213EP1101X
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

8704 Rolling Rd
Manassas, VA 20110-4253

Mailing address

8704 Rolling Rd
Manassas, VA 20110-4253
Phone (703) 361-3132

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20131004000035 VA Part B Supplier - Clinic/Group Practice 6406080555 Receives reassigned benefits from 4 practitioners
Practice locations: Manassas, VA
O20151027001088 DC Part B Supplier - Clinic/Group Practice 6406080555 Receives reassigned benefits from 1 practitioner
Practice locations: Manassas, VA
O20160203003035 VA DME Supplier - Physician - Podiatry 6406080555 Practice locations: Manassas, VA

National Provider Directory

National Provider Directory

Locations

8704 Rolling Rd
Manassas, VA 20110
Phone (703) 361-3132

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1184050650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8704 ROLLING RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104253",
            "telephone_number": "703-361-3132",
            "fax_number": "703-368-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8704 ROLLING RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104253",
            "telephone_number": "703-361-3132",
            "fax_number": "703-368-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANASSAS FOOT CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-17",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-361-3132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.