Individual provider Active NPI

Frederic Thomas Farra, MD

Interventional Cardiology Physician
Winchester, VA

National Provider Identifier

1265494959

Registry record updated Jan 6, 2015

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Winchester, VA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License: 0101041773 Issued in VA
Practice address: 190 Campus Blvd
Suite 201
Winchester, VA 22601
Phone: (540) 662-0306
Fax: (540) 542-1843
NPI assigned: Apr 6, 2006
Last updated: Jan 6, 2015By the provider in NPPES
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 3

Specialty (taxonomy)	Code	License	State	Primary
Cardiovascular Disease Physician	207RC0000X	0101041773	VA
Interventional Cardiology Physician	207RI0011X	0101041773	VA	Primary
Interventional Cardiology Physician	207RI0011X	25172	WV

Addresses

Primary practice location

190 Campus Blvd
Suite 201
Winchester, VA 22601

Mailing address

190 Campus Blvd
Suite 201
Winchester, VA 22601
Phone (540) 662-0306

Other identifiers 14

Identifier	Type	State	Issuer
3810003817	Other	WV	WV MEDICAID GROUP
P00656329	Other		RAILROAD MEDICARE
006056954	Medicaid	VA
550941600	Other	MD	MD MEDICAID GROUP
08243200000	Other		QUALCHOICE PROFESSIONAL
001717440	Other		WV BLUE SHIELD
44153	Other		SENTARA PROFESSIONAL
C00085	Other		VA MEDICARE B GROUP #
000875693	Other		WV BLUE SHIELD GROUP #
072370	Other		ANTHEM PROFESSIONAL
2119636	Other		MAMSI PROFESSIONAL
286101100	Medicaid	MD
0085544000	Medicaid	WV
006056954	Other		VA MEDICAID PROFESSIONAL

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Winchester Medical Center		Current	Accepting new patients

Locations

1840 Amherst St
Winchester, VA 22601
Phone (540) 536-8700

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.

Winchester Medical Center

dba Valley Intensivists
- Critical Care Medicine (Internal Medicine) Physician
- Winchester, VA
- NPI 1679711261
NPD

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1265494959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 CAMPUS BLVD",
            "address_2": "SUITE 201",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "22601",
            "telephone_number": "540-662-0306",
            "fax_number": "540-542-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 CAMPUS BLVD",
            "address_2": "SUITE 201",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "22601",
            "telephone_number": "540-662-0306",
            "fax_number": "540-542-1843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRA",
        "first_name": "FREDERIC",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101041773",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "VA",
            "license": "0101041773",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WV",
            "license": "25172",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV MEDICAID GROUP",
            "identifier": "3810003817",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00656329",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006056954",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD MEDICAID GROUP",
            "identifier": "550941600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE PROFESSIONAL",
            "identifier": "08243200000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BLUE SHIELD",
            "identifier": "001717440",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA PROFESSIONAL",
            "identifier": "44153",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA MEDICARE B GROUP #",
            "identifier": "C00085",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BLUE SHIELD GROUP #",
            "identifier": "000875693",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROFESSIONAL",
            "identifier": "072370",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PROFESSIONAL",
            "identifier": "2119636",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286101100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085544000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA MEDICAID PROFESSIONAL",
            "identifier": "006056954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, VA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.