NPIMap

Individual provider Active NPI

Victoria Leigh Takubo, PA-C

  • Surgical Physician Assistant
  • South Charleston, WV
National Provider Identifier
1194032227
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1484 Issued in WV
Practice address
4610 Kanawha Ave SW Ste 401
South Charleston, WV 25309-1367
Phone
(304) 768-7368
Fax
(304) 768-1829
NPI assigned
Sep 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01484 WV
Surgical Physician Assistant 363AS0400X 1484 WV Primary

Addresses

Primary practice location

4610 Kanawha Ave SW Ste 401
South Charleston, WV 25309-1367

Mailing address

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Other practice location 1

4605 MacCorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Other names 1

  • Victoria Leigh Mullins Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address victoria.takubo@thomashealthsystem.direct-ci.com
Direct Messaging Address victoria.takubo@thomashealthsystem.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20101116000612 WV Practitioner - Physician Assistant 9537354584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

4607 Maccorkle Ave SW
South Charleston, WV 25309-1364

Hospital & facility affiliations

  • Thomas Memorial Hospital Hospital, South Charleston, WV, CCN 510029
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Boone Memorial Hospital Hospital, Madison, WV, CCN 511313
  • Jackson General Hospital Hospital, Ripley, WV, CCN 511320
  • Logan Regional Medical Center Hospital, Logan, WV, CCN 510048

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
01484WVMDMedical Physician Assistant
1484WVMDSurgical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: victoria.takubo@thomashealthsystem.direct-ci.com

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1194032227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-414-4800",
            "fax_number": "304-414-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 KANAWHA AVE SW STE 401",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091367",
            "telephone_number": "304-768-7368",
            "fax_number": "304-768-1829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4605 MacCorkle Ave SW",
            "address_purpose": "LOCATION",
            "city": "South Charleston",
            "state": "WV",
            "postal_code": "253091311",
            "country_code": "US",
            "telephone_number": "304-414-4800",
            "fax_number": "304-414-4801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAKUBO",
        "first_name": "VICTORIA",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-10",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01484",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WV",
            "license": "1484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "victoria.takubo@thomashealthsystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "4610 Kanawha Ave SW Ste 401",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253091367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "victoria.takubo@thomashealthsystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "4605 MacCorkle Ave SW",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253091311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "MULLINS",
            "middle_name": "LEIGH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.