Individual provider Active NPI

Virginia G Boyle, AUD CCC A SLP

  • Audiologist
  • Diamondhead, MS
National Provider Identifier
1073519211
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
A1020 Issued in MS
Practice address
5439 W Aloha Dr
Ste B
Diamondhead, MS 39525-3374
Phone
(228) 255-8889
Fax
(228) 255-0890
NPI assigned
Jun 22, 2005
Last updated
Aug 13, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A1020 MS Primary
Speech-Language Pathologist 235Z00000X S1020 MS

Addresses

Primary practice location

5439 W Aloha Dr
Ste B
Diamondhead, MS 39525-3374

Mailing address

5439 W Aloha Dr
Ste B
Diamondhead, MS 39525-3374
Phone (228) 255-8889

Other identifiers 6

IdentifierTypeStateIssuer
09015355MedicaidMS
1573753OtherMSCIGNA
7636062OtherMSAETNA
876174OtherMSHUMANA
125360700OtherMSAUDIOLOGY DEPT OF LABOR
512I640002OtherMSMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111110000693 MS Practitioner - Qualified Speech Language Pathologist 0446339972 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A1020MSMDAudiologist

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.

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218585600000",
    "number": "1073519211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5439 W ALOHA DR",
            "address_2": "STE B",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253374",
            "telephone_number": "228-255-8889",
            "fax_number": "228-255-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5439 W ALOHA DR",
            "address_2": "STE B",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253374",
            "telephone_number": "228-255-8889",
            "fax_number": "228-255-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYLE",
        "first_name": "VIRGINIA",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "AUD CCC A SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MS",
            "license": "A1020",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S1020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015355",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1573753",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7636062",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "876174",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AUDIOLOGY DEPT OF LABOR",
            "identifier": "125360700",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "512I640002",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamondhead, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.