Organization Active NPI

Commonwealth Ear, Nose & Throat Specialists PC

  • Otolaryngology Physician
  • Midlothian, VA
National Provider Identifier
1720190390
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
010122975 Issued in VA
Legal business name
COMMONWEALTH EAR, NOSE & THROAT SPECIALISTS PC
Practice address
14051 St Francis Blvd
Suite 2211
Midlothian, VA 23114-3201
Phone
(540) 345-3556
Fax
(540) 342-2193
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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

Authorized official

Name
Patrick J Gibbons, M.D.NPI 1336142124
Title
President
Phone
(540) 345-3556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 010122975 VA Primary

Addresses

Primary practice location

14051 St Francis Blvd
Suite 2211
Midlothian, VA 23114-3201

Mailing address

PO Box 8310
Roanoke, VA 24014-0310
Phone (540) 345-3556

Other identifiers 2

IdentifierTypeStateIssuer
269573OtherVAANTHEM
006501478MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061207000267 VA Part B Supplier - Clinic/Group Practice 4284633934 Receives reassigned benefits from 10 practitioners
Practice locations: Midlothian, VA; Richmond, VA

National Provider Directory

National Provider Directory

Locations

14051 St Francis Blvd
Ste 2211
Midlothian, VA 23114
Phone (804) 378-7443

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1720190390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8310",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240140310",
            "telephone_number": "540-345-3556",
            "fax_number": "540-342-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14051 ST FRANCIS BLVD",
            "address_2": "SUITE 2211",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231143201",
            "telephone_number": "540-345-3556",
            "fax_number": "540-342-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH EAR, NOSE & THROAT SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-345-3556",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "010122975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "269573",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006501478",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; 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.