Individual provider Active NPI

Nicole Elizabeth Campbell, CMA

  • Obstetrics & Gynecology Nurse Practitioner
  • Winchester, VA
National Provider Identifier
1053835819
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
0024175362 Issued in VA
Practice address
1705 Amherst St Ste 203
Winchester, VA 22601-3346
Phone
(540) 662-0711
Fax
(540) 722-3269
NPI assigned
Aug 2, 2017
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
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 0024175362 VA Primary

Addresses

Primary practice location

1705 Amherst St Ste 203
Winchester, VA 22601-3346

Mailing address

1705 Amherst St Ste 203
Winchester, VA 22601-3346
Phone (540) 662-0711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171107002569 VA Practitioner - Certified Nurse Midwife (CNM) 0244596229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

1705 Amherst St
Suite 203
Winchester, VA 22601-3346
Phone (540) 662-0711

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Medical Assistant, Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Obstetrics & Gynecology CurrentSince Sep 15, 2017 Accepting new patients
Privia Medical Group, LLC CurrentSince Sep 15, 2017 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

8644 Sudley Rd
#220
Manassas, VA 20110

1705 Amherst St
Ste 203
Winchester, VA 22601
Phone (540) 662-0711

1705 Amherst St
Ste 250
Winchester, VA 22601

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: nicole.campbell.1@8042.direct.athenahealth.com

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": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1053835819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 AMHERST ST STE 203",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226013346",
            "telephone_number": "540-662-0711",
            "fax_number": "540-722-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 AMHERST ST STE 203",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226013346",
            "telephone_number": "540-662-0711",
            "fax_number": "540-722-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "CMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2022-07-21",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "VA",
            "license": "0024175362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, VA

Sources for this page

Verify at the official NPI Registry.