Individual provider Active NPI

Jessica M. Tsukanov, DO

  • Family Medicine Physician
  • Richmond, VA
National Provider Identifier
1114273463
Registry record updated Sep 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102204221 Issued in VA
Practice address
1250 E Marshall St
Dept. of Family Medicine and Population Health
Richmond, VA 23298-5051
Phone
(804) 828-5883
Fax
(804) 828-5399
NPI assigned
Jul 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102204221 VA Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 0102204221 VA

Addresses

Primary practice location

1250 E Marshall St
Dept. of Family Medicine and Population Health
Richmond, VA 23298-5051

Mailing address

PO Box 91734
Richmond, VA 23291-1734
Phone (804) 358-6100

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160126000026 VA Practitioner - Family Practice 9234357831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1001 E Leigh St
Richmond, VA 23298-5004
Phone (804) 828-7929

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102204221VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians Family Medicine CurrentSince Sep 2, 2015 Accepting new patients

Locations

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

1001 E Leigh St
Richmond, VA 23298
Phone (804) 628-7497

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

2000 Wilkes Ridge Pl
Richmond, VA 23233
Phone (804) 342-4349

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.

Hospital & facility affiliations 2

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": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1114273463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91734",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232911734",
            "telephone_number": "804-358-6100",
            "fax_number": "804-342-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E MARSHALL ST",
            "address_2": "DEPT. OF FAMILY MEDICINE AND POPULATION HEALTH",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985051",
            "telephone_number": "804-828-5883",
            "fax_number": "804-828-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSUKANOV",
        "first_name": "JESSICA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-24",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102204221",
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "VA",
            "license": "0102204221",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.