Active NPI
Bede A.R. Pantaze, PHD
- Clinical Psychologist
- Richmond, VA
National Provider Identifier
1326005356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810002816
- Practice address
- 9702 Gayton Rd
#181
Richmond, VA 23238-4907 - Phone
- (804) 741-7500
- Fax
- (804) 741-7900
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810002816 | VA | Primary |
Addresses
Primary practice location
9702 Gayton Rd
#181
Richmond, VA 23238-4907
Mailing address
P.O. Box 586
Glasgow, VA 24555
Phone (540) 461-5555
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007712537 | Medicaid | VA | |
| 245585 | Other | VA | BLUE CROSS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810002816 | VA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chapman Senior Care, Inc. | Clinical | Past | Accepting new patients |
| DGS Audiology Inc | Past | Accepting new patients | |
| Friendship Health and Rehab Center South Inc | Past | 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.
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-
- Skilled Nursing Facility
- Roanoke, VA
- NPI 1346616422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1326005356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 586",
"city": "GLASGOW",
"state": "VA",
"postal_code": "24555",
"telephone_number": "540-461-5555",
"fax_number": "804-741-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9702 GAYTON RD",
"address_2": "#181",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232384907",
"telephone_number": "804-741-7500",
"fax_number": "804-741-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANTAZE",
"first_name": "BEDE",
"middle_name": "A.R.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810002816",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007712537",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PIN",
"identifier": "245585",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.