NPIMap

Individual provider Active NPI

Elizabeth Dunne, PA-C

  • Physician Assistant
  • Fort Campbell, KY
National Provider Identifier
1114459922
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1114459922 Issued in VA
Practice address
650 Joel Dr
Fort Campbell, KY 42223-5318
Phone
(270) 956-0667
NPI assigned
Mar 30, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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 1114459922 VA Primary

Addresses

Primary practice location

650 Joel Dr
Fort Campbell, KY 42223-5318

Mailing address

1714 E Hundred Rd
Ste 104
Chester, VA 23836-3310
Phone (804) 681-0556

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
I20211001002082 VA Practitioner - Physician Assistant 3375810831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Birmingham Medical College, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richmond Gastroenterology Associates, Inc.Group PAC ID 8426950692, 39 clinicians

Practice addresses (Care Compare)

165 Wadsworth Dr
North Chesterfield, VA 23236-4500
Phone (804) 330-4901

169 Wadsworth Dr
North Chesterfield, VA 23236-4500
Phone (804) 330-4021

215 Wadsworth Dr
North Chesterfield, VA 23236-4510
Phone (804) 330-4021

223 Wadsworth Dr
North Chesterfield, VA 23236-4510
Phone (804) 330-4021

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1114459922VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gastrointestinal Specialists LLC Physician Assistant Past Accepting new patients
Infusion Solutions LLC Past Accepting new patients

Organizations & group practices 3

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1114459922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 E HUNDRED RD",
            "address_2": "STE 104",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238363310",
            "telephone_number": "804-681-0556",
            "fax_number": "804-410-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-956-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNNE",
        "first_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-30",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "1114459922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

Verify at the official NPI Registry.