Individual provider Active NPI

Brendan Michael McConnell, D.P.M.

  • Podiatrist
  • Yorktown, VA
National Provider Identifier
1194731042
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
0103000726 Issued in VA
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

Updated by the provider on Jul 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
1194731042OtherVABLUE CROSS BLUE SHIELD
1194731042OtherVAUNITED HEALTHCARE
480006732OtherVARAILROAD MEDICARE
009300104MedicaidVA
1194731042OtherVAOPTIMA
1194731042OtherVAMULTIPLAN
1194731042OtherVATRICARE
1194731042OtherVACIGNA
1194731042OtherVAVIRGINIA HEALTH NETWORK
1194731042OtherVAHUMANA
1194731042OtherVAPHCS
1194731042OtherVAMAMSI
4122283OtherVAAETNA

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
I20110606000687 VA Practitioner - Podiatry 5597730481

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: 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

Verify at the official NPI Registry.