Jay Miles Forman, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0110003739 Issued in VA

Practice address

7544 Hospital Dr
Suite 202a
Gloucester, VA 23061-4178

Phone

(804) 693-0529

Fax

(804) 693-1670

NPI assigned

Jul 26, 2010

Last updated

Nov 26, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Merit-based Incentive Payment System (MIPS)

Final score

94.91 of 100Reported as apm

Quality

92.86

Promoting interoperability

94.93

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jforman12432@direct.rivhs.com

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.

• Riverside Physician Services Inc

  dba Riverside Gastroenterology Specialists

  • Gastroenterology Physician
  • Newport News, VA
  • NPI 1194929026
  Medicare reassignment
• Riverside Physician Services Inc

  dba Riverside Gastroenterology Specialists Williamsburg

  • Gastroenterology Physician
  • Williamsburg, VA
  • NPI 1083867311
  NPD
• Riverside Physician Services Inc

  dba Riverside Primary Care Midtown

  • Primary Care Clinic/Center
  • Williamsburg, VA
  • NPI 1861414609
  NPD
• Riverside Physician Services Inc

  dba Riverside Emergency Physicians

  • Emergency Medicine Physician
  • Williamsburg, VA
  • NPI 1639418429
  NPD (past)

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385424000000",
    "number": "1073826517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 J CLYDE MORRIS BLVD",
            "address_2": "SUITE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7544 HOSPITAL DR",
            "address_2": "SUITE 202A",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230614178",
            "telephone_number": "804-693-0529",
            "fax_number": "804-693-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JAY",
        "middle_name": "MILES",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-26",
        "last_updated": "2013-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110003739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Ferguson, LPC
• James Fish, M.D., FACEP
• Cary Nelson Fishburne, M.D.
• Harriette B Fishburne, M.D.
• Hannah Fleming, CSAC, NCACII, QMHP-A
• Dana Foster, RPRS
• Foundational Intervention and Therapy
• Karen S. Fowlkes, LPC
• Allison Kade Fox, MD
• Francis N. Sanders Nursing Home, Inc (Riverside Lifelong Health & Rehabilitation Sanders)

• Surgical Physician Assistant in Gloucester, VA
• Providers in Gloucester, VA by specialty
• Surgical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.