NPIMap

Individual provider Active NPI

Kim Waters

  • Physician Assistant
  • Fredericksburg, VA
National Provider Identifier
1619521861
Registry record updated Mar 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3310 Fall Hill Ave
Fredericksburg, VA 22401-3000
Phone
(540) 373-4602
NPI assigned
Jul 26, 2019
Last updated
Mar 3, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

3310 Fall Hill Ave
Fredericksburg, VA 22401-3000

Mailing address

3310 Fall Hill Ave
Fredericksburg, VA 22401-3000
Phone (540) 373-4602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200324002514 VA Practitioner - Physician Assistant 5092143180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthovirginia IncGroup PAC ID 0547157224, 570 clinicians

Practice addresses (Care Compare)

1115 Boulders Pkwy
North Chesterfield, VA 23225-4067

12216 W Broad St
Suite 4B 5
Henrico, VA 23233-1062
Phone (804) 440-4878

5899 Bremo Rd
Suite 100
Richmond, VA 23226-1935
Phone (804) 288-8512

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.85 of 100Reported as group
Quality
90.74
Promoting interoperability
100
Improvement activities
40
Cost
78.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthovirginia, Inc CurrentSince May 17, 2021 Accepting new patients
Orthovirginia, Inc. Physician Assistant CurrentSince May 17, 2021 Accepting new patients
Orthovirginia, Inc. Past Accepting new patients

Locations

8200 Meadowbridge Rd
Ste 200
Mechanicsville, VA 23116
Phone (804) 560-5595

1115 Boulders Pkwy
Ste 200
North Chesterfield, VA 23225
Phone (804) 327-9242

Interoperability endpoints

  • Direct secure messaging: kwaters29703@direct.orthovirginia.com

Organizations & group practices 4

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 6

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": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1619521861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 FALL HILL AVE",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013000",
            "telephone_number": "540-373-4602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 FALL HILL AVE",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224013000",
            "telephone_number": "540-373-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "KIM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.