Virginia Ann Buccola, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Tacoma, WA
NPI 1124398482 · NPPES record last updated Jan 29, 2019
Key facts
- NPI
- 1124398482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- AP60296557 (WA)
- Practice address
- 1202 MLK Jr Way
Tacoma, WA 98405 - Phone
- (253) 441-4743
- Fax
- (253) 620-5831
- NPI assigned
- Jan 4, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Health Care
Practice addresses (Care Compare)
1202 Martin Luther King Jr Way
Tacoma, WA 98405-3926
Phone (253) 441-4742
1708 E 44TH St
Tacoma, WA 98404-4611
Phone (253) 471-4553
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121207000499 | WA | Practitioner - Nurse Practitioner | 4789836289 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Care | Current |
Accepting new patients | |
| Community Health Care | Current |
Accepting new patients |
Locations
134 188th St S
Spanaway, WA 98387
Phone (253) 847-2304
1202 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 441-4742
1148 Broadway
Ste 100
Tacoma, WA 98402
Phone (253) 441-4742
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HEDCAA
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- virginia.buccolatournay.p1@direct.chc-tacoma.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN00125750 | WA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | AP60296557 | WA | Yes |
Addresses
Primary practice location
1202 MLK Jr Way
Tacoma, WA 98405
Mailing address
405 6TH Ave
Apt 503
Tacoma, WA 98402
Phone (253) 620-5015
Other providers in Tacoma, WA
- Alysse Bryson
- Jason Thomas Brzuchalski
- Sarah M Buban
- Brent Thomas Bubany
- Ashley Marie Bublitz
- Daniel Robert Buchanan
- Izabella Anna Buchanan
- Jason R Buchanan
- Justin Daniel Buchanan
- Kelsie Marie Buchanan
All providers in Tacoma, WA · Psychiatric/Mental Health Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.