Individual provider Active NPI

Lorella Addis, PA-C

  • Physician Assistant
  • Virginia Beach, VA
National Provider Identifier
1851337273
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110007629 Issued in VA
Practice address
101 N Lynnhaven Rd Ste 100
Virginia Beach, VA 23452-7523
Phone
(866) 934-7450
NPI assigned
Jun 22, 2006
Last updated
Apr 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NA 050936 PA
Physician Assistant 363A00000X 0110007629 VA Primary

Addresses

Primary practice location

101 N Lynnhaven Rd Ste 100
Virginia Beach, VA 23452-7523

Mailing address

4600 Montgomery Rd Ste 400
Cincinnati, OH 45212-2600

Other practice location 1

340 Montage Mountain Rd
Moosic, PA 18507-1782
Phone (570) 346-3686

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
I20230519002567 VA Practitioner - Physician Assistant 3173692969 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NA 050936PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brightview LLC CurrentSince Apr 3, 2023 Accepting new patients
Brightview LLC CurrentSince Apr 3, 2023 Accepting new patients

Locations

4600 Montgomery Rd
Ste 400
Cincinnati, OH 45212
Phone (513) 873-1269

3704 Old Forest Rd
Lynchburg, VA 24501

101 N Lynnhaven Rd
Ste 100
Virginia Beach, VA 23452
Phone (757) 264-9957

Organizations & group practices 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1851337273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MONTGOMERY RD STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N LYNNHAVEN RD STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527523",
            "telephone_number": "866-934-7450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 Montage Mountain Rd",
            "address_purpose": "LOCATION",
            "city": "Moosic",
            "state": "PA",
            "postal_code": "185071782",
            "country_code": "US",
            "telephone_number": "570-346-3686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDIS",
        "first_name": "LORELLA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "NA 050936",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.