Robert John Waselovich, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110004578 Issued in VA

Practice address

320 Hospital Dr
Martinsville, VA 24112-1900

Phone

(218) 213-2768

NPI assigned

Dec 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Sports & Family Wellness, PLLC

  • Medical Specialty Clinic/Center
  • Hopkins, MN
  • NPI 1982030706
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1316121981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 HOSPITAL DR",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241121900",
            "telephone_number": "218-213-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 HOSPITAL DR",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241121900",
            "telephone_number": "218-213-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASELOVICH",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-19",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316121981",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Hamilton Walrod, DDS
• Francis X Walsh, MD
• Serenity Chantelle Ward
• Mark C Warner, RPH
• Celeste M Warren, DPT
• Susanne Brinegar Washburn
• Robert Watkins
• Vanessa Watkins
• Waymaker Transportation Services LLC
• Sarah Elizabeth Webb, LMSW

• Physician Assistant in Martinsville, VA
• Providers in Martinsville, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.