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

Last updated

Apr 23, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Interventional Pain & Spine Specialists, PLLC

  • Pain Medicine Physician
  • Chester, VA
  • NPI 1275834814
  Medicare reassignment

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

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• Wendy Lorraine Cerritos
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• Surgical Physician Assistant in Chester, VA
• Providers in Chester, VA by specialty
• 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.