Individual provider Active NPI

Nareg Sam Churukian, DO

  • Emergency Medicine Physician
  • Fredericksburg, VA
National Provider Identifier
1629456678
Registry record updated Jul 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0102205638 Issued in VA
Practice address
1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone
(517) 788-4800
Fax
(517) 817-7050
NPI assigned
May 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MI
Emergency Medicine Physician 207P00000X 0102205638 VA Primary

Addresses

Primary practice location

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453

Mailing address

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453

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
I20190910001685 VA Practitioner - Emergency Medicine 3779896519 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fredericksburg Emergency Medical Alliance, Inc.Group PAC ID 2163412636, 47 clinicians

Practice addresses (Care Compare)

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-1167

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Associates of Fredericksburg PTR Current Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Jul 16, 2019 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Jul 16, 2019 Accepting new patients
Fredericksburg Emergency Medical Alliance, Inc. Emergency Medicine CurrentSince Jul 19, 2019 Accepting new patients

Locations

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

101 Hospital Center Blvd
Stafford, VA 22554
Phone (540) 741-3340

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563580800000",
    "number": "1629456678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014453",
            "telephone_number": "517-788-4800",
            "fax_number": "517-817-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURUKIAN",
        "first_name": "NAREG",
        "middle_name": "SAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2019-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102205638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.