Individual provider Active NPI

Theodora Anna Squire

  • Student in an Organized Health Care Education/Training Program
  • Glen Allen, VA
National Provider Identifier
1417591660
Registry record updated Oct 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2151 Old Brick Rd
Glen Allen, VA 23060-5837
Phone
(703) 850-8981
NPI assigned
Oct 31, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2151 Old Brick Rd
Glen Allen, VA 23060-5837

Mailing address

2151 Old Brick Rd
Glen Allen, VA 23060-5837
Phone (703) 850-8981

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220606002855 VA Practitioner - Physician Assistant 1456739382 Reassigns benefits to 1 organization
I20220720002888 DC Practitioner - Physician Assistant 1456739382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gastroenterology Associates of Northern Virginia, LLCGroup PAC ID 1759371008, 98 clinicians

Practice addresses (Care Compare)

1939 Roland Clarke PL
Suite 200
Reston, VA 20191-1445
Phone (703) 766-2650

3022 Williams Dr
Suite 301
Fairfax, VA 22031-4600
Phone (703) 698-8960

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.52 of 100Reported as group
Quality
56.13
Promoting interoperability
98
Improvement activities
40
Cost
80.61

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Old Dominion Anesthesia LLC Past Accepting new patients
Galloway Anesthesia Associates LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: theodora.squire@gastrohealth.eclinicaldirectplus.com

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 3

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": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572480000000",
    "number": "1417591660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 OLD BRICK RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230605837",
            "telephone_number": "703-850-8981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 OLD BRICK RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230605837",
            "telephone_number": "703-850-8981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUIRE",
        "first_name": "THEODORA",
        "middle_name": "ANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2019-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.