Individual provider Active NPI

Viktoriia Passaro, FNP-BC

  • Family Nurse Practitioner
  • Statesville, NC
National Provider Identifier
1003688839
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5020553 Issued in NC
Practice address
1804 Davie Ave
Statesville, NC 28677-3524
Phone
(704) 873-7250
Fax
(704) 878-9457
NPI assigned
Oct 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 041.455121 IL
Family Nurse Practitioner 363LF0000X 5020553 NC Primary

Addresses

Primary practice location

1804 Davie Ave
Statesville, NC 28677-3524

Mailing address

PO Box 1845
Statesville, NC 28687-1845
Phone (704) 873-4277

Other practice location 1

801 Villa St
Elgin, IL 60120-8001
Phone (630) 892-4355

Other practice location 2

400 N Highland Ave
Aurora, IL 60506-3814
Phone (630) 593-7985

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821002612 NC Practitioner - Nurse Practitioner 1557718293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Healthcare PAGroup PAC ID 9638070683, 226 clinicians

Practice addresses (Care Compare)

556 Kitchings Dr
Statesville, NC 28677-3588
Phone (704) 838-8255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041.455121ILMDMedical-Surgical Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Healthcare, P.a. CurrentSince Sep 16, 2024 Accepting new patients
Piedmont Healthcare, PA CurrentSince Sep 16, 2024 Accepting new patients

Locations

556 Kitchings Dr
Statesville, NC 28677
Phone (704) 838-8255

1804 Davie Ave
Statesville, NC 28677
Phone (704) 873-7250

650 Signal Hill Drive Ext
Statesville, NC 28625
Phone (704) 873-4277

208 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-8215

Organizations & group practices 2

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": "1698192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1003688839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286871845",
            "telephone_number": "704-873-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773524",
            "telephone_number": "704-873-7250",
            "fax_number": "704-878-9457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Villa St",
            "address_purpose": "LOCATION",
            "city": "Elgin",
            "state": "IL",
            "postal_code": "601208001",
            "country_code": "US",
            "telephone_number": "630-892-4355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605063814",
            "country_code": "US",
            "telephone_number": "630-593-7985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSARO",
        "first_name": "VIKTORIIA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-25",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "IL",
            "license": "041.455121",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5020553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.