Terry L Ketchersid

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101054573 Issued in VA

Practice address

2232 Wilborn Ave
South Boston, VA 24592

Phone

(434) 517-3914

Fax

(434) 517-3912

NPI assigned

Jul 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18733/brand/1/csg/1/fhir/r4

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.

• Danville Urologic Clinic Inc

  dba Southside Urology & Nephrology

  • Nephrology Physician
  • Danville, VA
  • NPI 1619927100
  NPD (past)
• Piedmont Day Surgery Center Inc

  • Ambulatory Surgical Clinic/Center
  • Danville, VA
  • NPI 1821064031
  NPD (past)
• Pulmonary Associates of Southside Virginia, Inc

  • Specialist
  • South Boston, VA
  • NPI 1265436117
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609881192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1115",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "24592",
            "telephone_number": "434-517-3515",
            "fax_number": "434-572-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "24592",
            "telephone_number": "434-517-3914",
            "fax_number": "434-517-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHERSID",
        "first_name": "TERRY",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101054573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "188149",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Jaszcz, DPT
• Suresh Gehan Jayatilaka, M.D.
• Warren Stephen Jones
• Christopher Charles Kemp, P.A.
• Marie Kathleen Ketchersid, MD
• Kwang W Kim, DDS
• Broderick Daryl King, MD
• Samantha Y King, MD
• Deborah Kipps-Vaughan, PSY. D.
• Senecca Elliott Kirkhart, CPNP

• Internal Medicine Physician in South Boston, VA
• Providers in South Boston, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.