NPIMap

Individual provider Active NPI

Fawad Virk, M.D

  • Interventional Cardiology Physician
  • Rolla, MO
National Provider Identifier
1396150165
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
2021016790 Issued in MO
Practice address
1050 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 308-1301
Fax
(573) 202-2480
NPI assigned
Jun 30, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 2021016790 MO Primary
Internal Medicine Physician 207R00000X 4301105011 MI
Cardiovascular Disease Physician 207RC0000X 2021016790 MO
Cardiovascular Disease Physician 207RC0000X BP10059060 TX

Addresses

Primary practice location

1050 W 10TH St
Rolla, MO 65401-2905

Mailing address

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 1

2799 W Grand Blvd
Henry Ford Hospital Medical Education Department
Detroit, MI 48202-2608
Phone (313) 916-1601

Other practice location 2

301 University Blvd
Galveston, TX 77555-2608
Phone (409) 772-1553

Other practice location 3

7703 Floyd Curl Dr
San Antonio, TX 78229-3901
Phone (210) 567-4602

Other practice location 4

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 5

1050 W 10th St
Rolla, MO 65401-2905
Phone (573) 458-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210604001107 MO Practitioner - Interventional Cardiology 6608094297 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pcrmc Medical Group IncGroup PAC ID 1557454063, 113 clinicians

Practice addresses (Care Compare)

1000 W 10TH St
Rolla, MO 65401-2905
Phone (573) 458-8899

1050 W 10TH St
Rolla, MO 65401-2905
Phone (573) 364-9000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301105011MIMDInternal Medicine Physician
BP10059060TXMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phelps County Regional Medical Center CurrentSince Aug 1, 2021 Accepting new patients
Pcrmc Medical Group, Inc Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Phelps County Regional Medical Center CurrentSince Oct 29, 2021 Accepting new patients

Locations

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1396150165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-308-1301",
            "fax_number": "573-202-2480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2799 W Grand Blvd",
            "address_2": "Henry Ford Hospital Medical Education Department",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 University Blvd",
            "address_purpose": "LOCATION",
            "city": "Galveston",
            "state": "TX",
            "postal_code": "775552608",
            "country_code": "US",
            "telephone_number": "409-772-1553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7703 Floyd Curl Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782293901",
            "country_code": "US",
            "telephone_number": "210-567-4602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-458-8899",
            "fax_number": "573-341-5611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIRK",
        "first_name": "FAWAD",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2021016790",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301105011",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2021016790",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "BP10059060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.