NPIMap

Organization Active NPI

Manassas Foot Clinic Inc

  • Foot & Ankle Surgery Podiatrist
  • Manassas, VA
National Provider Identifier
1578637633
Registry record updated Dec 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0103001009 Issued in VA
Legal business name
MANASSAS FOOT CLINIC INC
Practice address
8704 Rolling Rd
Manassas, VA 20110-4253
Phone
(703) 361-3132
Fax
(703) 368-0291
NPI assigned
Nov 20, 2006
Last updated
Dec 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2012

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

Authorized official

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X 0103001009 VA Primary
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X 0103000268 VA

Addresses

Primary practice location

8704 Rolling Rd
Manassas, VA 20110-4253

Mailing address

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

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1578637633",
    "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 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2012-12-18",
        "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": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "VA",
            "license": "0103001009",
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "VA",
            "license": "0103000268",
            "primary": false
        }
    ],
    "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 Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.