NPIMap

Organization Active NPI

Dominion Cardiology PC

  • Cardiovascular Disease Physician
  • Petersburg, VA
National Provider Identifier
1386923639
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
0101246823 Issued in VA
Legal business name
DOMINION CARDIOLOGY PC
Practice address
2563 S Crater Rd
Petersburg, VA 23805-2407
Phone
(804) 520-1080
Fax
(804) 520-1906
NPI assigned
Aug 4, 2011
Last updated
Dec 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Authorized official

Name
Nadeem A Faruqi, MDNPI 1205886900
Title
President
Phone
(804) 520-1080

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 0101246823 VA Primary

Addresses

Primary practice location

2563 S Crater Rd
Petersburg, VA 23805-2407

Mailing address

2563 S Crater Rd
Petersburg, VA 23805-2407
Phone (804) 520-1080

Other identifiers 1

IdentifierTypeStateIssuer
1205886900MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110923000611 VA Part B Supplier - Clinic/Group Practice 1658542576 Receives reassigned benefits from 5 practitioners
Practice locations: Petersburg, VA

National Provider Directory

National Provider Directory

Locations

2563 S Crater Rd
Petersburg, VA 23805
Phone (804) 520-1080

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1386923639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2563 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052407",
            "telephone_number": "804-520-1080",
            "fax_number": "804-520-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2563 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238052407",
            "telephone_number": "804-520-1080",
            "fax_number": "804-520-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION CARDIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-04",
        "last_updated": "2021-12-07",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "FARUQI",
        "authorized_official_first_name": "NADEEM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-520-1080",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101246823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205886900",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.