NPIMap

Organization Active NPI

Commonwealth Vascular Institute

  • Vascular Surgery Physician
  • Suffolk, VA
National Provider Identifier
1194004093
Registry record updated Aug 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
0101053967 Issued in VA
Legal business name
COMMONWEALTH VASCULAR INSTITUTE
Practice address
150 Burnetts Way
Suite 200
Suffolk, VA 23434-8168
Phone
(757) 539-7824
Fax
(757) 538-9474
NPI assigned
Aug 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2012

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

Authorized official

Name
Ms. Bonnie Wright, CPC-A, CPC-H-A
Title
Billing Supervisor
Phone
(757) 539-7824

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 0101053967 VA
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 0101053967 VA Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X 0101053967 VA

Addresses

Primary practice location

150 Burnetts Way
Suite 200
Suffolk, VA 23434-8168

Mailing address

150 Burnetts Way
Suite 200
Suffolk, VA 23434-8168
Phone (757) 539-7824

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110927000497 VA Part B Supplier - Clinic/Group Practice 1658542493 Receives reassigned benefits from 9 practitioners
Practice locations: Suffolk, VA

National Provider Directory

National Provider Directory

Locations

150 Burnetts Way
Ste 100B
Suffolk, VA 23434

1520 Breezeport Way
Suffolk, VA 23435

1520 Breezeport Way
Ste 100
Suffolk, VA 23435
Phone (757) 638-1823

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346198400000",
    "number": "1194004093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BURNETTS WAY",
            "address_2": "SUITE 200",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348168",
            "telephone_number": "757-539-7824",
            "fax_number": "757-538-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BURNETTS WAY",
            "address_2": "SUITE 200",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348168",
            "telephone_number": "757-539-7824",
            "fax_number": "757-538-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH VASCULAR INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2012-08-29",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "757-539-7824",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC-A, CPC-H-A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101053967",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "VA",
            "license": "0101053967",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "VA",
            "license": "0101053967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.