Tami Lynn Rickey, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0024165943 Issued in VA

Practice address

4700 Puddledock Road
Suite 300
Prince George, VA 23875-1268

Phone

(804) 526-1111

Fax

(804) 526-8363

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tami Broadwater Former name

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

Specialty

Nurse Practitioner

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prime Care Family Practice PCGroup PAC ID 5799738035, 7 clinicians

Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
• John Randolph Medical Center Hospital, Hopewell, VA, CCN 490020

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tami.rickey@pcfp.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/HGEACA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prime Care Family Practice, P.C.

  • Family Medicine Physician
  • Prince George, VA
  • NPI 1881629384
  Medicare reassignment Care Compare group NPD
• Shenandoah Valley Medical System, Inc.

  • Federally Qualified Health Center (FQHC)
  • Martinsburg, WV
  • NPI 1235853144
  NPD (past)

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

• Bon Secours Mercy Health Petersburg LLC

  • General Acute Care Hospital
  • Petersburg, VA
  • NPI 1720623853
  Care Compare affiliation
• Columbia/HCA John Randolph, Inc.

  • General Acute Care Hospital
  • Hopewell, VA
  • NPI 1285671248
  Care Compare affiliation

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1760403141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 PUDDLEDOCK ROAD",
            "address_2": "SUITE 300",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751268",
            "telephone_number": "804-526-1111",
            "fax_number": "804-526-8363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 PUDDLEDOCK ROAD",
            "address_2": "SUITE 300",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751268",
            "telephone_number": "804-526-1111",
            "fax_number": "804-526-8363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICKEY",
        "first_name": "TAMI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "VA",
            "license": "0024165943",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024165943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005641276",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMI",
            "last_name": "BROADWATER",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pure Path Counseling LLC
• Helen Lanier Ramirez
• Corey Todd Resnick, MD
• Riccobene & Associates CC, DDS, PC
• Karen L Richmond, FNP-C
• David Page Roberts Jr., D.D.S.
• Kristen Robinson, MSOT OTR/L
• William Rosenberger II, M.D.
• Ruthanne Elise Rowane, OTD, OTR/L
• Laura Ashley Samuels, PT

• Nurse Practitioner in Prince George, VA
• Providers in Prince George, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.