Individual provider Active NPI

Michole M Pineda, MD

  • Developmental - Behavioral Pediatrics Physician
  • Roanoke, VA
National Provider Identifier
1386679389
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
0101058349 Issued in VA
Practice address
4348 Electric Rd
Roanoke, VA 24018-0720
Phone
(540) 769-0976
Fax
(540) 857-5386
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101058349 VA
Developmental - Behavioral Pediatrics Physician 2080P0006X 0101058349 VA Primary

Addresses

Primary practice location

4348 Electric Rd
Roanoke, VA 24018-0720

Mailing address

1030 S Jefferson St
Suite 201
Roanoke, VA 24016-4418

Other identifiers 1

IdentifierTypeStateIssuer
5904969MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpineda46235@direct.carilionclinic.org Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120808000666 VA Practitioner - Pediatric Medicine 8123274008 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Jul 16, 2012 Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Carilion Medical Center CurrentSince Jul 16, 2012 Accepting new patients
Carilion Giles Community Hospital Current Accepting new patients
Carilion Giles Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Carilion Medical Center Past Accepting new patients

Locations

159 Hartley Way
Pearisburg, VA 24134
Phone (540) 921-6000

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

1030 S Jefferson St
Ste 201
Roanoke, VA 24016
Phone (540) 224-4520

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

4348 Electric Rd
Roanoke, VA 24018
Phone (540) 769-0600

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: mpineda46235@direct.carilionclinic.org

Organizations & group practices 6

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1386679389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 S JEFFERSON ST",
            "address_2": "SUITE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4348 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240180720",
            "telephone_number": "540-769-0976",
            "fax_number": "540-857-5386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINEDA",
        "first_name": "MICHOLE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101058349",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "VA",
            "license": "0101058349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904969",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpineda46235@direct.carilionclinic.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mpineda46235@direct.carilionclinic.org",
            "address_1": "1030 S Jefferson St",
            "address_2": "Suite 201",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240164418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.