Individual provider Active NPI

Pastien Peou, MS, PA-C

  • Physician Assistant
  • Newport News, VA
National Provider Identifier
1760719777
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110003982 Issued in VA
Practice address
500 J Clyde Morris Boulevard
Newport News, VA 23601
Phone
(757) 594-2000
NPI assigned
Nov 11, 2009
Last updated
Apr 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

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 0110003982 VA Primary

Addresses

Primary practice location

500 J Clyde Morris Boulevard
Newport News, VA 23601

Mailing address

860 Omni Blvd
Ste 303
Newport News, VA 23606-4477
Phone (757) 232-8769

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
I20130211000412 VA Practitioner - Physician Assistant 5395914907 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.24 of 100Reported as group
Quality
75.4
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
4549AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc CurrentSince Feb 1, 2013 Accepting new patients
Riverside Physician Services Inc CurrentSince Feb 1, 2013 Accepting new patients
Riverside Physician Services, Inc. Past Accepting new patients
Riverside Physician Services Inc Past Accepting new patients

Locations

7519 Hospital Dr
Gloucester, VA 23061
Phone (804) 693-8800

500 J Clyde Morris Blvd
North North, VA 23601
Phone (757) 594-2000

1500 Commonwealth Ave
Williamsburg, VA 23185
Phone (757) 585-2200

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1760719777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD",
            "address_2": "STE 303",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064477",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 J CLYDE MORRIS BOULEVARD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23601",
            "telephone_number": "757-594-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEOU",
        "first_name": "PASTIEN",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-11",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.