Willoughby Shelton Hundley III, M.D.
Individual provider Active NPI Emergency Medicine Physician · Boydton, VA
NPI 1457328767 · NPPES record last updated May 3, 2024
Key facts
- NPI
- 1457328767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 0101034527 (VA)
- Practice address
- 969 Madison Street
Suite/Box 297
Boydton, VA 23917 - Phone
- (434) 738-6911
- Fax
- (434) 738-0431
- NPI assigned
- Mar 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Virginia Commonwealth University, School of Medicine, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Vidant Medical Group LLC
Practice addresses (Care Compare)
500 S Academy St
Vidant Heart Failure
Ahoskie, NC 27910-3261
Phone (252) 209-3260
Hospital & facility affiliations
- Vidant Roanoke Chowan Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.95 of 100
- Quality
- 82.44
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070117000520 | NC | Practitioner - Emergency Medicine |
6002817012 | Reassigns benefits to 1 organization |
| I20100504000537 | VA | Practitioner - Family Practice |
6002817012 |
Reassigns benefits to 3 organizations Practice locations: Chase City, VA; Clarksville, VA; South Hill, VA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vidant Medical Group LLC | Current |
Accepting new patients | |
| Mecklenburg Family Practice | Family Medicine | Current | Accepting new patients |
| Vidant Medical Group LLC | Current |
Accepting new patients | |
| Alexandria Springfield Emergency Physicians PC | Emergency Medicine | Current |
Accepting new patients |
| Alexandria Springfield Emergency Physicians PC | Emergency Medicine | Current |
Accepting new patients |
| Emergency Medicine Associates P.a., P.C. | Current |
Accepting new patients | |
| Emergency Coverage, LLC | Emergency Medicine | Current |
Accepting new patients |
| Emergency Medicine Associates, P.a.,P.C. | Current |
Accepting new patients | |
| Emergency Coverage Services, PC | Past | Accepting new patients | |
| Community Memorial Healthcenter | Past | Accepting new patients | |
| United Emergency Services, Inc. | Emergency Medicine | Past | Accepting new patients |
Locations
500 Academy St S
Ahoskie, NC 27910
Phone (252) 209-3000
401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941
969 Madison St
Boydton, VA 23917
Phone (434) 476-4863
969 Madison St
#297
Boydton, VA 23917
Phone (434) 738-6911
60 E Roslyn Ct
Colonial Hgts, VA 23834
Phone (804) 281-8100
142 S Main St
Danville, VA 24541
Phone (434) 799-2100
727 N Main St
Emporia, VA 23847
Phone (434) 348-4400
15225 Heathcote Blvd
Haymarket, VA 20169
Phone (571) 284-1000
5818 Harbour View Blvd
Suffolk, VA 23435
Phone (757) 673-5800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 0101034527 | VA | Yes |
| Emergency Medicine Physician | 207P00000X | 9801679 | NC | |
| Family Medicine Physician | 207Q00000X | 9801679 | NC | |
| Family Medicine Physician | 207Q00000X | 0101034527 | VA |
Addresses
Primary practice location
969 Madison Street
Suite/Box 297
Boydton, VA 23917
Mailing address
PO Box 297
Boydton, VA 23917-0297
Phone (434) 738-6911
Other practice location 1
349 Madison St
Boydton, VA 23917
Phone (434) 738-8359
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5644810 | Medicaid | VA | |
| 265659 | Other | VI | ANTHEM |
Other providers in Boydton, VA
- David William Eason
- Efficient Transportation Services
- Marie Goodwin
- Carolyn Shores Hoyle
- Jan L Hundley
- Robin H. Jennings
- Journey to Peace, LLC
- KLM Pediatric Therapy Services
- Carolyn B Leach
- T'Onna Logan
All providers in Boydton, VA · Emergency Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.