Individual provider Active NPI

Surin Rodino

  • Adult Health Nurse Practitioner
  • Springfield, VA
National Provider Identifier
1215280946
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
0024168874 Issued in VA
Practice address
7410 Spring Village Dr
Springfield, VA 22150-4485
Phone
(703) 923-4644
Fax
(703) 923-4625
NPI assigned
Oct 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 0024168874 VA Primary

Addresses

Primary practice location

7410 Spring Village Dr
Springfield, VA 22150-4485

Mailing address

5525 Research Park Dr
4TH Floor
Baltimore, MD 21228-4873
Phone (703) 923-4644

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180221003095 VA Practitioner - Nurse Practitioner 3678724713 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0024168874VAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Erickson Health Medical Group of Virginia PC Adult Health Past Accepting new patients
Michael D Kim MD PC PastSince Jun 15, 2003 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1215280946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 RESEARCH PARK DR",
            "address_2": "4TH FLOOR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212284873",
            "telephone_number": "703-923-4644",
            "fax_number": "703-923-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7410 SPRING VILLAGE DR",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221504485",
            "telephone_number": "703-923-4644",
            "fax_number": "703-923-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODINO",
        "first_name": "SURIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024168874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VA

Sources for this page

Verify at the official NPI Registry.