Individual provider Active NPI

Darin Poulsen

  • Physician Assistant
  • Fishersville, VA
National Provider Identifier
1659942464
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110-007960 Issued in VA
Practice address
78 Medical Center Dr
Fishersville, VA 22939-2332
Phone
(540) 332-4000
NPI assigned
Jul 2, 2021
Last updated
Jul 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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 0110-007960 VA Primary

Addresses

Primary practice location

78 Medical Center Dr
Fishersville, VA 22939-2332

Mailing address

158 Lofty Cir
Stuarts Draft, VA 24477-3234
Phone (801) 573-8001

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210823001086 VA Practitioner - Physician Assistant 3971908419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Augusta Medical GroupGroup PAC ID 3678632544, 409 clinicians

Practice addresses (Care Compare)

53 S Medical Park Dr
Fishersville, VA 22939-2333
Phone (540) 332-5687

78 Medical Ctr Dr
Fishersville, VA 22939-2332
Phone (540) 332-5595

9 S Medical Park Dr
Fishersville, VA 22939-2333
Phone (540) 245-7350

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110-007960VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Augusta Medical Group CurrentSince Aug 16, 2021 Accepting new patients

Locations

540 Radford Ln
Ste 250
Charlottesville, VA 22903
Phone (434) 823-7596

53 S Medical Park Dr
Fishersville, VA 22939
Phone (540) 332-5687

78 Medical Center Dr
Fishersville, VA 22939
Phone (540) 245-7216

78 Medical Center Dr
Fl 1
Fishersville, VA 22939

644 University Blvd
Harrisonburg, VA 22801
Phone (540) 564-5100

30 Greenhouse Rd
Lexington, VA 24450
Phone (540) 464-3465

Interoperability endpoints

  • Direct secure messaging: darin.poulsen.1@14718.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14718/brand/4/csg/1/fhir/r4

Organizations & group practices 1

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 2

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": "1625184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1659942464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 LOFTY CIR",
            "city": "STUARTS DRAFT",
            "state": "VA",
            "postal_code": "244773234",
            "telephone_number": "801-573-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 MEDICAL CENTER DR",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392332",
            "telephone_number": "540-332-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSEN",
        "first_name": "DARIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-02",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-007960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.