NPIMap

Individual provider Active NPI

Boyd Roy Wickizer Jr., M.D.

  • Emergency Medicine Physician
  • Petersburg, VA
National Provider Identifier
1750330353
Registry record updated Dec 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101047692 Issued in VA
Practice address
200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone
(804) 765-5949
Fax
(804) 765-6250
NPI assigned
May 9, 2006
Last updated
Dec 23, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0101047692 VA Primary
Surgery Physician 208600000X 0101047692 VA

Addresses

Primary practice location

200 Medical Park Blvd
Petersburg, VA 23805-9274

Mailing address

PO Box 446
Midlothian, VA 23113-0446
Phone (804) 858-3998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081028000321 VA Practitioner - Emergency Medicine 7416029590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Arizona College of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

611 Watkins Centre Pkwy
Suite 150
Midlothian, VA 23114-4715
Phone (804) 893-8477

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue555
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101047692VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boyd R Wickizer MD LLC CurrentSince Apr 25, 2017 Accepting new patients
Virginia Em-I Medical Services, PC Emergency Medicine Past Accepting new patients
Southside Physician Network LLC Surgery Past Accepting new patients

Locations

611 Watkins Centre Pkwy
Ste 150
Midlothian, VA 23114
Phone (804) 765-6715

3335 S Crater Rd
Ste 700
Petersburg, VA 23805
Phone (804) 504-8100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/679/brand/1/csg/319/fhir/r4

Organizations & group practices 3

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 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261526400000",
    "number": "1750330353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231130446",
            "telephone_number": "804-858-3998",
            "fax_number": "804-765-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059274",
            "telephone_number": "804-765-5949",
            "fax_number": "804-765-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKIZER",
        "first_name": "BOYD",
        "middle_name": "ROY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2009-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101047692",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101047692",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.