NPIMap

Individual provider Active NPI

Troy West Pulliam, PAC

  • Medical Physician Assistant
  • Victoria, VA
National Provider Identifier
1821068024
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110001214 Issued in VA
Practice address
1508 KV Road
Victoria, VA 23974
Phone
(434) 696-2165
Fax
(434) 696-1557
NPI assigned
Jan 23, 2006
Last updated
Feb 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110001214 VA Primary

Addresses

Primary practice location

1508 KV Road
Victoria, VA 23974

Mailing address

PO Box 65
Victoria, VA 23974-0065
Phone (434) 696-3584

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
I20061202000166 VA Practitioner - Physician Assistant 5092714980 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110001214VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Health Professional Services LLC CurrentSince Mar 8, 2017 Accepting new patients
Southern Dominion Health System, Inc. Current Accepting new patients
Southern Dominion Health System, Inc. CurrentSince Feb 9, 2020 Accepting new patients
Centra Medical Group, LLC CurrentSince Mar 8, 2017 Accepting new patients
Southern Dominion Health System, Inc. CurrentSince Feb 29, 2020 Accepting new patients
Burkeville Medical Group Past Accepting new patients
Commonwealth Neuro Specialists PC Past Accepting new patients
Centra Medical Group Southside, LLC 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

  • Direct secure messaging: troy.pulliam@sdhs.directbygreenway.com

Organizations & group practices 8

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1821068024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65",
            "city": "VICTORIA",
            "state": "VA",
            "postal_code": "239740065",
            "telephone_number": "434-696-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 KV ROAD",
            "city": "VICTORIA",
            "state": "VA",
            "postal_code": "23974",
            "telephone_number": "434-696-2165",
            "fax_number": "434-696-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLIAM",
        "first_name": "TROY",
        "middle_name": "WEST",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110001214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, VA

Sources for this page

Verify at the official NPI Registry.