NPIMap

Organization Active NPI

Virginia South Psychiatric & Family Services

  • Psychiatry Physician
  • Petersburg, VA
National Provider Identifier
1700894466
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VIRGINIA SOUTH PSYCHIATRIC & FAMILY SERVICES
Practice address
269 Medical Park Blvd
Petersburg, VA 23805
Phone
(804) 861-0700
Fax
(804) 863-4626
NPI assigned
Aug 4, 2006
Last updated
Sep 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Authorized official

Name
Anthony Joseph Vadella
Title
Practice Administrator
Phone
(804) 518-6504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

269 Medical Park Blvd
Petersburg, VA 23805

Mailing address

269 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 518-6504

Other identifiers 1

IdentifierTypeStateIssuer
010325994MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001272 VA Part B Supplier - Clinic/Group Practice 3476443797 Receives reassigned benefits from 52 practitioners
Practice locations: Midlothian, VA; Petersburg, VA; Hopewell, VA

National Provider Directory

National Provider Directory

Locations

207 N 4th Ave
Hopewell, VA 23860
Phone (804) 518-6513

13901 Coalfield Commons Pl
Midlothian, VA 23114
Phone (804) 420-1200

13901 Coalfield Commons Pl
Ste 102
Midlothian, VA 23114
Phone (804) 378-0800

269 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 861-0700

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72142

Practitioners & affiliated clinicians

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 73

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1700894466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-518-6504",
            "fax_number": "804-863-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-861-0700",
            "fax_number": "804-863-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA SOUTH PSYCHIATRIC & FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "VADELLA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "804-518-6504"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010325994",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.