Active NPI
Pediatric Associates of Charlottesville
- Audiologist
- Charlottesville, VA
National Provider Identifier
1659441608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 2201000509
- Legal business name
- PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE
- Practice address
- 1011 E Jefferson St
Charlottesville, VA 22902-5354 - Phone
- (434) 296-9161
- NPI assigned
- Nov 8, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kerry Kovarik
- Title
- Office Manager
- Phone
- (434) 296-9161
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 2201000509 | VA | Primary |
Addresses
Primary practice location
1011 E Jefferson St
Charlottesville, VA 22902-5354
Mailing address
1011 E Jefferson St
Charlottesville, VA 22902-5354
Phone (434) 296-9161
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01107700000 | Other | VA | SOUTHERN HEALTH |
| 8773895002 | Other | VA | CIGNA |
| 9450271 | Medicaid | VA | |
| 451205 | Other | VA | TRIGON/BLUE CROSS BLUE SH |
National Provider Directory
National Provider Directory- Tax ID family
- Kelson Physician Partners of Charlottesville
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Kelson Physician Partners of Charlottesville
- Pediatrics Physician
- Charlottesville, VA
- NPI 1528178787
Locations
1011 E Jefferson St
Charlottesvle, VA 22902
Phone (434) 296-9161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1659441608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 E JEFFERSON ST",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229025354",
"telephone_number": "434-296-9161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 E JEFFERSON ST",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229025354",
"telephone_number": "434-296-9161"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-08",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KOVARIK",
"authorized_official_first_name": "KERRY",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "434-296-9161",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "VA",
"license": "2201000509",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH",
"identifier": "01107700000",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8773895002",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9450271",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIGON/BLUE CROSS BLUE SH",
"identifier": "451205",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.