Individual provider Active NPI

Bennett Lloyd Wolansky, D.P.M.

  • Foot Surgery Podiatrist
  • Davie, FL
National Provider Identifier
1679550388
Registry record updated Jun 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
PO0002066 Issued in FL
Practice address
4601 S University Dr
Davie, FL 33328-3817
Phone
(954) 680-7133
Fax
(954) 680-7135
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X PO0002066 FL Primary

Addresses

Primary practice location

4601 S University Dr
Davie, FL 33328-3817

Mailing address

4601 S University Dr
Davie, FL 33328-3817
Phone (954) 680-7133

Other identifiers 1

IdentifierTypeStateIssuer
052006300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO0002066FLMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
LMD Podiatry LLC Foot Surgery CurrentSince Dec 1, 2022 Accepting new patients
Boca Deerfield Foot Care Center Inc Past Accepting new patients
Victoria a Gensemer D.P.M., P.a. Foot Surgery PastSince Apr 30, 2006 Accepting new patients

Locations

4601 S University Dr
Davie, FL 33328
Phone (804) 216-0807

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277510400000",
    "number": "1679550388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283817",
            "telephone_number": "954-680-7133",
            "fax_number": "954-680-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 S UNIVERSITY DR",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283817",
            "telephone_number": "954-680-7133",
            "fax_number": "954-680-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLANSKY",
        "first_name": "BENNETT",
        "middle_name": "LLOYD",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2010-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO0002066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052006300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

Verify at the official NPI Registry.