Teri Ann Bistarkey, LCSW
Individual provider Active NPI Clinical Social Worker · South Hill, VA
NPI 1629047865 · NPPES record last updated Oct 27, 2014
Key facts
- NPI
- 1629047865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0904004677 (VA)
- Practice address
- 314 E Atlantic St
South Hill, VA 23970-2006 - Phone
- (434) 447-8381
- Fax
- (434) 447-8381
- NPI assigned
- Mar 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230217002066 | VA | Practitioner - Clinical Social Worker | 6103869425 | Reassigns benefits to 1 organization |
| I20231028000058 | DC | Practitioner - Clinical Social Worker | 6103869425 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current |
Accepting new patients |
| Western Tidewater Community Mental | Past |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904004677 | VA | Yes |
Addresses
Primary practice location
314 E Atlantic St
South Hill, VA 23970-2006
Mailing address
PO Box 876
Bracey, VA 23919-0876
Phone (434) 447-8381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912197559 | Medicaid | VA | |
| 1912197559 | Other | VA | NPI |
Other providers in South Hill, VA
- John Marshall Bass
- Bbeads of America LLC
- Bebold Recovery LLC
- Janet Lee Biancardi
- Victoria Simmons Bishop
- Eric Blackwell
- Mackenzie Jean Blackwell
- Bailey Lynn Bowen
- Elizabeth Yancey Bowlin
- Bernita Danica Boyd
All providers in South Hill, VA · Clinical Social Worker in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.