Fancy Gap Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FANCY GAP INTERNAL MEDICINE

Practice address

1661 Turner Spur Rd
Fancy Gap, VA 24328-4365

Phone

(276) 728-0735

Fax

(276) 728-7717

NPI assigned

Dec 2, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Tracy Roberts, NP-CNPI 1730453283

Title

Nurse Practitioner

Phone

(336) 707-7734

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Tracy Roberts, NP-C

  • Nurse Practitioner
  • Fancy Gap, VA
  • NPI 1730453283

  Single Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1376940643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 TURNER SPUR RD",
            "city": "FANCY GAP",
            "state": "VA",
            "postal_code": "243284365",
            "telephone_number": "276-728-0735",
            "fax_number": "276-728-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 TURNER SPUR RD",
            "city": "FANCY GAP",
            "state": "VA",
            "postal_code": "243284365",
            "telephone_number": "276-728-0735",
            "fax_number": "276-728-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANCY GAP INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "TRACY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "336-707-7734",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Marie Davis
• Fancy Gap Internal Medicine (Susan Tracy Roberts)
• H & S Enterprises, Inc.
• Susan Lee Jones, LPTA
• Allison Mitchell
• Susan Tracy Roberts, NP-C
• John William Tracy, MD

• Internal Medicine Physician in Fancy Gap, VA
• Providers in Fancy Gap, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.