Active NPI
Brendan Michael McConnell, D.P.M.
- Podiatrist
- Yorktown, VA
National Provider Identifier
1194731042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 0103000726
- Practice address
- 4030 George Washington Mem Hwy Ste B
Yorktown, VA 23692-2619 - Phone
- (757) 898-5500
- Fax
- (757) 898-8001
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 0103000726 | VA | Primary |
Addresses
Primary practice location
4030 George Washington Mem Hwy Ste B
Yorktown, VA 23692-2619
Mailing address
730 Thimble Shoals Blvd
Suite 130
Newport News, VA 23606-4562
Phone (757) 873-1554
Other practice location 1
730 Thimble Shoals Blvd
Suite 130
Newport News, VA 23606-4562
Phone (757) 873-1554 ext. 33
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194731042 | Other | VA | BLUE CROSS BLUE SHIELD |
| 1194731042 | Other | VA | UNITED HEALTHCARE |
| 480006732 | Other | VA | RAILROAD MEDICARE |
| 009300104 | Medicaid | VA | |
| 1194731042 | Other | VA | OPTIMA |
| 1194731042 | Other | VA | MULTIPLAN |
| 1194731042 | Other | VA | TRICARE |
| 1194731042 | Other | VA | CIGNA |
| 1194731042 | Other | VA | VIRGINIA HEALTH NETWORK |
| 1194731042 | Other | VA | HUMANA |
| 1194731042 | Other | VA | PHCS |
| 1194731042 | Other | VA | MAMSI |
| 4122283 | Other | VA | AETNA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110606000687 | VA | Practitioner - Podiatry | 5597730481 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- bmcconnell@hrosm.gwaydirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1194731042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 THIMBLE SHOALS BLVD",
"address_2": "SUITE 130",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236064562",
"telephone_number": "757-873-1554",
"fax_number": "757-873-3239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 GEORGE WASHINGTON MEM HWY STE B",
"city": "YORKTOWN",
"state": "VA",
"postal_code": "236922619",
"telephone_number": "757-898-5500",
"fax_number": "757-898-8001"
}
],
"practiceLocations": [
{
"address_1": "730 Thimble Shoals Blvd",
"address_2": "Suite 130",
"address_purpose": "LOCATION",
"city": "Newport News",
"state": "VA",
"postal_code": "236064562",
"country_code": "US",
"telephone_number": "757-873-1554 x33",
"fax_number": "757-873-3239",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCCONNELL",
"first_name": "BRENDAN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "VA",
"license": "0103000726",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480006732",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009300104",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VIRGINIA HEALTH NETWORK",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "1194731042",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4122283",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Yorktown, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.