Troy West Pulliam, PAC
Individual provider Active NPI Medical Physician Assistant · Victoria, VA
NPI 1821068024 · NPPES record last updated Feb 6, 2020
Key facts
- NPI
- 1821068024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 0110001214 (VA)
- Practice address
- 1508 KV Road
Victoria, VA 23974 - Phone
- (434) 696-2165
- Fax
- (434) 696-1557
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 20
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern Dominion Health System Inc
Practice addresses (Care Compare)
1418 6TH St
Victoria, VA 23974-0070
Phone (434) 696-4180
1508 K V Rd
Victoria, VA 23974-2624
Phone (434) 696-2165
70 PO Box
Victoria, VA 23974
PO Box
Suite 70
Victoria, VA 23974
Hospital & facility affiliations
- Amedisys Home Health
- Community Memorial Hospital
- Southside Community Hospital, Inc
- Bon Secours St Francis Medical Center
- CJW Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061202000166 | VA | Practitioner - Physician Assistant | 5092714980 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centra Medical Group, LLC | Current |
Accepting new patients | |
| Centra Health Professional Services LLC | Current |
Accepting new patients | |
| Southern Dominion Health System, Inc. | Current |
Accepting new patients | |
| Southern Dominion Health System, Inc. | Current |
Accepting new patients | |
| Southern Dominion Health System, Inc. | Current |
Accepting new patients | |
| Commonwealth Neuro Specialists PC | Past | Accepting new patients | |
| Centra Medical Group Southside, LLC | Past | Accepting new patients | |
| Burkeville Medical Group | Past | Accepting new patients |
Locations
8920 Otterburn Rd
Amelia Ct Hse, VA 23002
Phone (804) 288-8838
412 Namozine St
#385
Burkeville, VA 23922
Phone (434) 767-5511
13855 Courthouse Rd
Dinwiddie, VA 23841
Phone (804) 469-3731
510 N Main St
Emporia, VA 23847
Phone (434) 634-7723
800 Oak St
Farmville, VA 23901
Phone (434) 315-2530
1901 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 200-3101
1508 K V Rd
Victoria, VA 23974
Phone (434) 696-2165
Interoperability endpoints
- troy.pulliam@sdhs.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0110001214 | VA | Yes |
Addresses
Primary practice location
1508 KV Road
Victoria, VA 23974
Mailing address
PO Box 65
Victoria, VA 23974-0065
Phone (434) 696-3584
Other providers in Victoria, VA
- Paul Chukwugozi Ohai
- Pamela Owens
- Nellie Parrish
- Amy Parsons
- Ashley Pollard
- Wendy Jones Pulliam
- Jordan Rafferty
- Shannon Rakes
- Zhara Sawyer
- Southern Dominion Health System Inc
All providers in Victoria, VA · Medical Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.