Active NPI
Edward Tubberville
- Student in an Organized Health Care Education/Training Program
- Fredericksburg, VA
National Provider Identifier
1649030156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453 - Phone
- (540) 741-9200
- Fax
- (540) 741-9201
- NPI assigned
- Mar 21, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Mailing address
530 W New Hope Rd Apt C1
Goldsboro, NC 27534-7586
Phone (321) 525-2741
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620000117 | VA | Order and Referring Only - Internal Medicine | 8022551993 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- etubberville120931@marywashingtonhealthcare.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747180800000",
"number": "1649030156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 W NEW HOPE RD APT C1",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275347586",
"telephone_number": "321-525-2741"
},
{
"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": "540-741-9200",
"fax_number": "540-741-9201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUBBERVILLE",
"first_name": "EDWARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-21",
"last_updated": "2025-05-14",
"certification_date": "2025-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.