NPIMap

Individual provider Active NPI

Ehtesham Mustafa, PA-C

  • Physician Assistant
  • Glen Allen, VA
National Provider Identifier
1104484609
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4900 Cox Rd Ste 150
Glen Allen, VA 23060-6507
Phone
(804) 346-1780
NPI assigned
May 30, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4900 Cox Rd Ste 150
Glen Allen, VA 23060-6507

Mailing address

4900 Cox Rd Ste 150
Glen Allen, VA 23060-6507
Phone (804) 346-1780

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
I20220110002731 VA Practitioner - Physician Assistant 6608208822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Virginia Physicians IncGroup PAC ID 5597650804, 93 clinicians

Practice addresses (Care Compare)

4900 Cox Rd
Glen Allen, VA 23060-6507
Phone (804) 346-1780

Hospital & facility affiliations

  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Physicians Inc CurrentSince Dec 1, 2021 Accepting new patients
Virginia Physicians, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Virginia Physicians, Inc. Past Accepting new patients

Locations

4900 Cox Rd
Ste 150
Glen Allen, VA 23060
Phone (804) 346-1780

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHBJBA
  • Direct secure messaging: ehtesham.mustafa@vpi.eclinicaldirectplus.com

Organizations & group practices 4

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 6

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": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1104484609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 COX RD STE 150",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606507",
            "telephone_number": "804-346-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 COX RD STE 150",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606507",
            "telephone_number": "804-346-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "EHTESHAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-30",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.