Carly Anne Wilson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110008398 Issued in VA

Practice address

25 Commerce Park Dr
Raphine, VA 24472-2547

Phone

(540) 490-2527

NPI assigned

Jan 10, 2022

Last updated

Mar 14, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Carly Anne Casto Former name

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Augusta Health Hospital, Fishersville, VA, CCN 490018
• University of Virginia Medical Center Hospital, Charlottesville, VA, CCN 490009

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.anne.wilson.1@8042.direct.athenahealth.com

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.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480
  Medicare reassignment Care Compare group NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD

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

• Augusta Health Care, Inc

  dba t/a Augusta Health

  • General Acute Care Hospital
  • Fishersville, VA
  • NPI 1053301127
  Care Compare affiliation
• Rector & Visitors of the University of Virginia

  dba UVA Health Sciences Center

  • General Acute Care Hospital
  • Charlottesville, VA
  • NPI 1780630608
  Care Compare affiliation

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1316698582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BALL DIAMOND TRL",
            "city": "VESUVIUS",
            "state": "VA",
            "postal_code": "244832901",
            "telephone_number": "540-421-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COMMERCE PARK DR",
            "city": "RAPHINE",
            "state": "VA",
            "postal_code": "244722547",
            "telephone_number": "540-490-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARLY ANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110008398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "CASTO",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Leigh Pacuch, PA-C
• Performa Tech Inc
• Ryan Timothy Pyles, PA-C, MPAS
• Victoria Peyton Tomlin, NP
• Janelle Weaver, MD, PHD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.