Active NPI
David Berardelli
- Prosthetics Case Management
- San Antonio, TX
National Provider Identifier
1659601946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- 209-10982
- Practice address
- 16607 Blanco Road
Suite 303
San Antonio, TX 78232-1940 - Phone
- (361) 230-0466
- Fax
- (210) 493-9504
- NPI assigned
- Jan 8, 2010
- Last updated
- Jan 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | 209-10982 | TX | Primary |
Addresses
Primary practice location
16607 Blanco Road
Suite 303
San Antonio, TX 78232-1940
Mailing address
16607 Blanco Road
Suite 303
San Antonio, TX 78232-1940
Phone (361) 230-0466
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C21287 | Other | TX | BOARD FOR ORTHOTISTS AND PROSTHISTS CERTIFICATION |
| 209-10982 | Other | TX | TEXAS BOARD OF ORTHOTISTS AND PROSTHECS LICENSE AND CONTROL # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-10982 | TX | MD | Prosthetics Case Management |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mahaffey Orthotics & Prosthetics Inc | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Prosthetic/Orthotic Supplier
- Amarillo, TX
- NPI 1073634127
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262908800000",
"number": "1659601946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16607 BLANCO ROAD",
"address_2": "SUITE 303",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782321940",
"telephone_number": "361-230-0466",
"fax_number": "210-493-9504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16607 BLANCO ROAD",
"address_2": "SUITE 303",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782321940",
"telephone_number": "361-230-0466",
"fax_number": "210-493-9504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERARDELLI",
"first_name": "DAVID",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-08",
"last_updated": "2010-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "TX",
"license": "209-10982",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD FOR ORTHOTISTS AND PROSTHISTS CERTIFICATION",
"identifier": "C21287",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS BOARD OF ORTHOTISTS AND PROSTHECS LICENSE AND CONTROL #",
"identifier": "209-10982",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.