Eleni B Tarasidis

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401415609 Issued in VA

Practice address

10160 Superior Way
Amelia Court House, VA 23002-4744

Phone

(804) 561-4379

NPI assigned

Apr 26, 2016

Last updated

Aug 3, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501718400000",
    "number": "1487009577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10160 SUPERIOR WAY",
            "city": "AMELIA COURT HOUSE",
            "state": "VA",
            "postal_code": "230024744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10160 SUPERIOR WAY",
            "city": "AMELIA COURT HOUSE",
            "state": "VA",
            "postal_code": "230024744",
            "telephone_number": "804-561-4379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARASIDIS",
        "first_name": "ELENI",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-26",
        "last_updated": "2017-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401415609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Dominion Health System, Inc. (Amelia Healthcare Center)
• Blufort Spencer
• Catherine C Staley, DDS
• Tina Staples
• Keshia Monik Stephens, NP
• Traveling Mercies,LLC
• Travis Mueller, DDS
• Walgreen Co (Walgreens #17920)
• Deana Weems, LPC, NCC
• William Wilkinson

• General Practice Dentistry in Amelia Court House, VA
• Providers in Amelia Court House, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.