NPIMap

Individual provider Active NPI

Ida E Sutherland, FNP-BC

  • Family Nurse Practitioner
  • Radford, VA
National Provider Identifier
1003925108
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024167940 Issued in VA
Practice address
600 Randolph St
Radford, VA 24141-2428
Phone
(540) 639-5300
Fax
(540) 639-4653
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024167940 VA Primary

Addresses

Primary practice location

600 Randolph St
Radford, VA 24141-2428

Mailing address

600 Randolph St
Radford, VA 24141-2428
Phone (540) 639-5300

Other identifiers 2

IdentifierTypeStateIssuer
1003925108OtherVAVA PREMIER
1003925108MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080915000572 VA Practitioner - Nurse Practitioner 5890862999 Reassigns benefits to 1 organization
Practice locations: Pulaski, VA

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Medical University of South Carolina College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health Clinic, Inc.Group PAC ID 9032250469, 3 clinicians

Practice addresses (Care Compare)

600 Randolph St
Radford, VA 24141-2428
Phone (540) 639-5300

Hospital & facility affiliations

  • Interim Healthcare Home health agency, Dublin, VA, CCN 497574
  • Amedisys Home Health Care Home health agency, Roanoke, VA, CCN 497275
  • Centerwell Home Health Home health agency, Roanoke, VA, CCN 497429
  • Valley Ridge Home Health Home health agency, Christiansburg, VA, CCN 497727
  • Carilion New River Valley Medical Center Hospital, Christiansburg, VA, CCN 490042
  • Lewisgale Hospital Pulaski Hospital, Pulaski, VA, CCN 490116
  • Lewisgale Hospital Montgomery Hospital, Blacksburg, VA, CCN 490110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024167940VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Clinic, Inc. CurrentSince Sep 25, 2017 Accepting new patients
Rivertown Primary Medical Past Accepting new patients
James M Vest MD PC Past Accepting new patients
Carilion Healthcare Corporation PastSince Sep 25, 2017 Accepting new patients
James M. Vest, MD PC Past Accepting new patients

Locations

600 Randolph St
Radford, VA 24141
Phone (540) 639-5300

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003925108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 RANDOLPH ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241412428",
            "telephone_number": "540-639-5300",
            "fax_number": "540-639-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 RANDOLPH ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241412428",
            "telephone_number": "540-639-5300",
            "fax_number": "540-639-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "IDA",
        "middle_name": "E",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024167940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA PREMIER",
            "identifier": "1003925108",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003925108",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Radford, VA

Sources for this page

Verify at the official NPI Registry.