Carol Sue Cdebaca, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0110002628 Issued in VA

Practice address

12901 Briggs Rd
Chester, VA 23831-5335

Phone

(804) 715-4709

Fax

(804) 715-4709

NPI assigned

Sep 26, 2007

Sex

Female

Sole proprietor

No

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.

• Interventional Pain & Spine Specialists, PLLC

  • Pain Medicine Physician
  • Chester, VA
  • NPI 1275834814

  VA

  Medicare reassignment

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: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: carol.cdebaca@hca6.eclinicaldirectplus.com
• Direct secure messaging: carol.cdebaca.1@6303.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 23, 2025.

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1154518900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12901 BRIGGS RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238315335",
            "telephone_number": "804-715-4709",
            "fax_number": "804-715-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12901 BRIGGS RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238315335",
            "telephone_number": "804-715-4709",
            "fax_number": "804-715-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CDEBACA",
        "first_name": "CAROL",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110002628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01464014",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA MEDICARE",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "540506332115",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN TOTAL",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA HEALTH PLAN",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCC VIRGINIA PREMIER",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID QMB",
            "identifier": "1154518900",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM MEDIGAP",
            "identifier": "1154518900",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caring Hands Community Services
• Jennifer Carlysle, LPC
• Carroll'S Transportation LLC
• Gabriel Castillo, BCBA
• Steven A Castro, D.D.S
• Center of Joy Psychological Services, PLLC
• Central Virginia Dental Care PLC
• Allison Baumgartner Cerreto, PHARMD
• Wendy Lorraine Cerritos
• Camille J Chalmers, M.S.

• All providers in Chester, VA
• Surgical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.