NPIMap

Organization Active NPI

Premier Anesthesia of Virginia LLC

  • Anesthesiology Physician
  • Woodbridge, VA
National Provider Identifier
1255986147
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PREMIER ANESTHESIA OF VIRGINIA LLC
Practice address
2300 Opitz Blvd
Woodbridge, VA 22191-3311
Phone
(404) 941-1210
NPI assigned
Aug 7, 2019
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Mr. Randy Walker
Title
Vice President Finance
Phone
(678) 690-7812

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU
Pain Medicine Physician 208VP0000X NU
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiologist Assistant 367H00000X NU

Addresses

Primary practice location

2300 Opitz Blvd
Woodbridge, VA 22191-3311

Mailing address

2655 Northwinds Pkwy
Alpharetta, GA 30009-2280

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200610001253 VA Part B Supplier - Clinic/Group Practice 1951722362 Receives reassigned benefits from 168 practitioners
Practice locations: South Boston, VA; Williamsburg, VA; Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

500 Northridge Rd
Ste 300
Sandy Springs, GA 30350

400 Sentara Cir
#200
Williamsburg, VA 23188
Phone (678) 690-7816

Practitioners & affiliated clinicians

Practitioners 171

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 171

NPI Registry JSON

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1255986147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 NORTHWINDS PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 OPITZ BLVD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913311",
            "telephone_number": "404-941-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ANESTHESIA OF VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "678-690-7812",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.