NPIMap

Individual provider Active NPI

Jeanne Kathleen Aggabao

  • Family Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1154733145
Registry record updated Sep 6, 2024
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Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024171689 Issued in VA
Practice address
3900 Hull Street Rd
Richmond, VA 23224-1714
Phone
(804) 292-7620
NPI assigned
May 23, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024171689 VA Primary

Addresses

Primary practice location

3900 Hull Street Rd
Richmond, VA 23224-1714

Mailing address

PO Box 746871
Atlanta, GA 30374-6871

Other practice location 1

3514 W Cary St
Richmond, VA 23221-2729
Phone (804) 355-8533

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
I20140923001084 VA Practitioner - Nurse Practitioner 2365660347 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh-VA Physicians Group PLLCGroup PAC ID 3274994470, 18 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

3900 Hull St Rd
Richmond, VA 23224-1714
Phone (804) 292-7620

9642 Burke Lake Rd
Burke, VA 22015-3052
Phone (703) 543-7920

Hospital & facility affiliations

  • HCA Virginia Healthcare at Home Home health agency, North Chesterfield, VA, CCN 497625
  • CJW Medical Center Hospital, Richmond, VA, CCN 490112
  • Henrico Doctors' Hospital Hospital, Richmond, VA, CCN 490118
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024171689VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Osh-VA Physicians Group PLLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

3900 Hull St Rd
Richmond, VA 23224
Phone (804) 292-7620

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 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": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1154733145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746871",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 HULL STREET RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232241714",
            "telephone_number": "804-292-7620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3514 W Cary St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232212729",
            "country_code": "US",
            "telephone_number": "804-355-8533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGGABAO",
        "first_name": "JEANNE KATHLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-23",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024171689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.