Individual provider Active NPI

Vivian H. Mao, M.D.

  • Otolaryngology Physician
  • Roanoke, VA
National Provider Identifier
1548264377
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
0101226188 Issued in VA
Practice address
102 Highland Ave SE
Ste 104
Roanoke, VA 24013-2255
Phone
(540) 343-4423
Fax
(540) 343-0495
NPI assigned
Jun 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 0101226188 VA
Otolaryngology Physician 207Y00000X 0101226188 VA Primary

Addresses

Primary practice location

102 Highland Ave SE
Ste 104
Roanoke, VA 24013-2255

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5715

Other identifiers 7

IdentifierTypeStateIssuer
010415691MedicaidVA
VA0103OtherVAJOHN DEERE
040015083OtherMEDICARE RR
299658OtherVAMAMSI
452106OtherVAANTHEM
6502783MedicaidVA
010415683MedicaidVA

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070601000491 VA Practitioner - Otolaryngology 0941197107 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Jefferson Medical College of Thomas Jefferson University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians
Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 981-7000

2017 Jefferson St SW
Roanoke, VA 24014-2419
Phone (540) 981-7925

2017 S Jefferson St
Roanoke, VA 24014-2419
Phone (540) 981-7128

2900 Lamb
700A
Christiansburg, VA 24073-6344
Phone (540) 731-7460

2900 Lamb Cir
Christiansburg, VA 24073-6344
Phone (540) 731-2992

4348 Electric Rd
Roanoke, VA 24018-0720
Phone (540) 769-0976

6415 Peters Creek Rd
Roanoke, VA 24019-4021
Phone (703) 562-2110

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Mar 1, 2007 Accepting new patients
Carilion Healthcare Corporation CurrentSince May 9, 2016 Accepting new patients
Carilion Healthcare Corporation CurrentSince May 9, 2016 Accepting new patients
Carilion Medical Center CurrentSince Mar 1, 2007 Accepting new patients
Carilion Medical Center Past Accepting new patients
Roanoke Ambulatory Surgery Center, LLC PastSince May 31, 2002 Accepting new patients

Locations

2900 Lamb Cir
Ste 310
Christiansburg, VA 24073

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

102 Highland Ave SE
Ste 104
Roanoke, VA 24013
Phone (540) 343-4423

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

4348 Electric Rd
Roanoke, VA 24018
Phone (540) 769-0600

6415 Peters Creek Rd
Roanoke, VA 24019
Phone (703) 562-2110

Interoperability endpoints

  • Direct secure messaging: vmao1387@direct.carilionclinic.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1548264377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5715",
            "fax_number": "540-224-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 HIGHLAND AVE SE",
            "address_2": "STE 104",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240132255",
            "telephone_number": "540-343-4423",
            "fax_number": "540-343-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAO",
        "first_name": "VIVIAN",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101226188",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101226188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010415691",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "VA0103",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "040015083",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "299658",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "452106",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6502783",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010415683",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.