NPIMap

Individual provider Active NPI

Ronald D Haggerty, MD

  • Internal Medicine Physician
  • Gloucester, VA
National Provider Identifier
1083702385
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101225016 Issued in VA
Practice address
6609 Main St
Gloucester, VA 23061-5194
Phone
(804) 824-9153
Fax
(804) 694-3174
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101225016 VA Primary

Addresses

Primary practice location

6609 Main St
Gloucester, VA 23061-5194

Mailing address

6609 Main St
Gloucester, VA 23061-5194
Phone (804) 824-9153

Other identifiers 1

IdentifierTypeStateIssuer
1083702385MedicaidVA

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
I20040610000966 VA Practitioner - Internal Medicine 7416930490 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rappahannock Westminster-Canterbury, Inc.Group PAC ID 6103090345, shared by 3 NPIs, 13 clinicians
Direct Access Internal Medicine LTDGroup PAC ID 1456538545, 5 clinicians

Practice addresses (Care Compare)

132 Lancaster Dr
Irvington, VA 22480-9740
Phone (804) 438-4000

6609 Main St
Gloucester, VA 23061-5194
Phone (804) 824-9153

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.02 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
70.07

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101225016VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Direct Access Internal Medicine LTD Internal Medicine CurrentSince Feb 24, 2011 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

6609 Main St
Gloucester, VA 23061
Phone (804) 824-9153

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449014400000",
    "number": "1083702385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6609 MAIN ST",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230615194",
            "telephone_number": "804-824-9153",
            "fax_number": "804-694-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6609 MAIN ST",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230615194",
            "telephone_number": "804-824-9153",
            "fax_number": "804-694-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGGERTY",
        "first_name": "RONALD",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101225016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083702385",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester, VA

Sources for this page

Verify at the official NPI Registry.