Individual provider Active NPI

Carrie Lee Cullin

  • Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1780422279
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024190752 Issued in VA
Practice address
2000 Wilkes Ridge Dr
Richmond, VA 23233-7632
Phone
(804) 877-4000
NPI assigned
Jul 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 0024190752 VA
Nurse Practitioner 363L00000X 0024190752 VA Primary

Addresses

Primary practice location

2000 Wilkes Ridge Dr
Richmond, VA 23233-7632

Mailing address

2000 Wilkes Ridge Dr
Richmond, VA 23233-7632
Phone (804) 669-5897

Other practice location 1

1250 E Marshall St
Richmond, VA 23298-5023
Phone (804) 828-9000

Other practice location 2

11958 W Broad St
Henrico, VA 23233-1007
Phone (804) 360-4669

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
I20241010002736 VA Practitioner - Nurse Practitioner 7012449481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Virginia Commonwealth University, School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

2000 Wilkes Ridge PL
Richmond, VA 23233-7336
Phone (804) 342-4349

Hospital & facility affiliations

  • Sheltering Arms Institute Inpatient rehabilitation facility, Richmond, VA, CCN 493036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024190752VAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians CurrentSince Aug 9, 2024 Accepting new patients

Locations

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

2000 Wilkes Ridge Dr
Richmond, VA 23233
Phone (804) 342-4349

11958 W Broad St
Richmond, VA 23233
Phone (804) 360-4669

2000 Wilkes Ridge Pl
Richmond, VA 23233
Phone (804) 342-4349

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1780422279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 WILKES RIDGE DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232337632",
            "telephone_number": "804-669-5897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 WILKES RIDGE DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232337632",
            "telephone_number": "804-877-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985023",
            "country_code": "US",
            "telephone_number": "804-828-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11958 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Henrico",
            "state": "VA",
            "postal_code": "232331007",
            "country_code": "US",
            "telephone_number": "804-360-4669",
            "fax_number": "804-364-6557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CULLIN",
        "first_name": "CARRIE",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024190752",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024190752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.