Individual provider Active NPI

Mathias Michael Pastore, DC

  • Chiropractor
  • Chester, VA
National Provider Identifier
1114021490
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
VA0104001122 Issued in VA
Practice address
12300 Bermuda Crossroads Lane
Chester, VA 23831
Phone
(804) 748-2763
Fax
(804) 796-2621
NPI assigned
Sep 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X VA0104001122 VA Primary

Addresses

Primary practice location

12300 Bermuda Crossroads Lane
Chester, VA 23831

Mailing address

12300 Bermuda Crossroads Lane
Chester, VA 23831
Phone (804) 748-2763

Other identifiers 1

IdentifierTypeStateIssuer
172877OtherANTHEM BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051004000471 VA Practitioner - Chiropractic 8921087958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12300 Bermuda Crossroad LN
Chester, VA 23831-2352
Phone (804) 748-2763

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
VA0104001122VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Breckenridge Chiropractic PC Chiropractor CurrentSince Jan 1, 2005 Accepting new patients

Locations

12300 Bermuda Crossroad Ln
#L
Chester, VA 23831
Phone (804) 748-2763

12300 Bermuda Crossroad Ln
Chester, VA 23831
Phone (804) 748-2763

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114021490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 BERMUDA CROSSROADS LANE",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "23831",
            "telephone_number": "804-748-2763",
            "fax_number": "804-796-2621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 BERMUDA CROSSROADS LANE",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "23831",
            "telephone_number": "804-748-2763",
            "fax_number": "804-796-2621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASTORE",
        "first_name": "MATHIAS",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "VA0104001122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "172877",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.