Active NPI
Kodi J Puckett, PA
- Medical Physician Assistant
- VA Beach, VA
National Provider Identifier
1184004475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 4092 Foxwood Dr
Ste 100
VA Beach, VA 23462-5225 - Phone
- (757) 686-3508
- Fax
- (757) 686-0541
- NPI assigned
- Jun 2, 2015
- Last updated
- Sep 4, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | VA | Primary |
Addresses
Primary practice location
4092 Foxwood Dr
Ste 100
VA Beach, VA 23462-5225
Mailing address
PO Box 7549
Portsmouth, VA 23707-0549
Phone (757) 686-3525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Eastern Virginia Medical School, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2800 Godwin Blvd
Suffolk, VA 23434-8038
Phone (757) 934-4000
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.87 of 100
- Quality
- 95.04
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Norfolk, VA
- NPI 1033136841
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441324800000",
"number": "1184004475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7549",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237070549",
"telephone_number": "757-686-3525",
"fax_number": "757-686-0541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4092 FOXWOOD DR",
"address_2": "STE 100",
"city": "VA BEACH",
"state": "VA",
"postal_code": "234625225",
"telephone_number": "757-686-3508",
"fax_number": "757-686-0541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "KODI",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-02",
"last_updated": "2015-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in VA Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.