Individual provider Active NPI

Samuel Pearce III, PA-C

  • Physician Assistant
  • Roanoke, VA
National Provider Identifier
1336508712
Registry record updated Jul 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110-005215 Issued in VA
Practice address
1906 Belleview Ave SE
Roanoke, VA 24014
Phone
(540) 981-7000
NPI assigned
Feb 15, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110-005215 VA Primary

Addresses

Primary practice location

1906 Belleview Ave SE
Roanoke, VA 24014

Mailing address

1906 Belleview Ave SE
Roanoke, VA 24014-1838

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160504001629 VA Practitioner - Physician Assistant 0648579193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000

2017 Jefferson St SW
Roanoke, VA 24014-2419
Phone (540) 981-7925

2017 S Jefferson St
Roanoke, VA 24014-2419
Phone (540) 981-7128

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110-005215VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Dec 11, 2017 Accepting new patients
Carilion Medical Center CurrentSince Dec 11, 2017 Accepting new patients

Locations

3700 S Main St
Blacksburg, VA 24060
Phone (540) 951-1111

213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

Interoperability endpoints

  • Direct secure messaging: spearce30607@direct.carilionclinic.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530835200000",
    "number": "1336508712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24014",
            "telephone_number": "540-981-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARCE",
        "first_name": "SAMUEL",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-15",
        "last_updated": "2018-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-005215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.