Paige C Proctor, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110006708 Issued in VA

Practice address

1309 Jamestown Rd Ste 102
Williamsburg, VA 23185-3380

Phone

(833) 516-0454

NPI assigned

Jun 14, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Paige C Fedro Former name

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

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  • NPI 1023865078
  Medicare reassignment Authorized official
• Chesapeake Weight Loss Consultants PLLC

  • Surgery Physician
  • Chesapeake, VA
  • NPI 1750661203
  Medicare reassignment

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1487214235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 JAMESTOWN RD STE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853380",
            "telephone_number": "833-516-0454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 JAMESTOWN RD STE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853380",
            "telephone_number": "833-516-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "PAIGE",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-14",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110006708",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAIGE",
            "last_name": "FEDRO",
            "middle_name": "C",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexander Prince
• Mary Helen Pringle, M.S.W., L.C.S.W.
• Theresa Pritchard, LCSW
• Sonia Re'Nee Pritchett, RN
• Michael Probert, PA-C
• Christen Hamilton Proffitt, C-FNP
• Teresa Dotson Prokup, CCC/SLP
• Deborah D Prosek, RPH.
• Nicole Jewel Pryor
• Megan A Przybysz, CRNA

• Physician Assistant in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.