Theresa Victoria Forty, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

0102205314 Issued in VA

Practice address

1900 Electric Rd
Salem, VA 24153

Phone

(540) 776-4000

NPI assigned

Apr 7, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, WV2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

West Virginia School of Osteopathic Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Spring Emergency Group LLCGroup PAC ID 6406103498, 51 clinicians

Kingsford Emergency Group, LLCGroup PAC ID 3870841117, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lewisgale Medical Center Hospital, Salem, VA, CCN 490048

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Kingsford Emergency Group, LLC

  • Emergency Medicine Physician
  • Pulaski, VA
  • NPI 1336631480
  Medicare reassignment Care Compare group NPD
• Lake Spring Emergency Group, LLC

  • Emergency Medicine Physician
  • Salem, VA
  • NPI 1215429600
  Medicare reassignment Care Compare group NPD
• Ingleside Emergency Group, LLC

  • Emergency Medicine Physician
  • Low Moor, VA
  • NPI 1144712662
  Medicare reassignment NPD
• Kingsford Physician Services, LLC

  • Hospitalist Physician
  • Pulaski, VA
  • NPI 1871088526
  Medicare reassignment NPD
• Wildwood Emergency Group, LLC

  • Emergency Medicine Physician
  • Blacksburg, VA
  • NPI 1013409721
  Medicare reassignment NPD
• Charleston Area Medical Center, Inc.

  • General Acute Care Hospital
  • Charleston, WV
  • NPI 1124248752
  Medicare reassignment NPD
• Charleston Area Medical Center Inc

  • Multi-Specialty Clinic/Center
  • Belpre, OH
  • NPI 1588422547
  NPD
• Charleston Area Medical Center, Inc.

  • Hospitalist Physician
  • Ronceverte, WV
  • NPI 1972125995

  Emergency Medicine

  NPD

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

• Lewis-Gale Medical Center, LLC

  • General Acute Care Hospital
  • Salem, VA
  • NPI 1619914785
  Care Compare affiliation

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1982022976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11885 E 12 MILE RD STE 300A",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933467",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 ELECTRIC RD",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "24153",
            "telephone_number": "540-776-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11885 E 12 Mile Rd Ste 300A",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "MI",
            "postal_code": "480933467",
            "country_code": "US",
            "telephone_number": "586-582-6630",
            "fax_number": "586-582-6631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTY",
        "first_name": "THERESA",
        "middle_name": "VICTORIA",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-07",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101020889",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102205314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foot and Ankle Associates of Southwest Virginia, P.C.
• Foot and Ankle Specialists of the Mid-Atlantic, LLC
• Foot and Ankle Specialists of the Mid-Atlantic, LLC
• Jeffrey A Forbes, M.D.
• Austin Forrester, DO
• Amy Beth Foutz, PT
• Jonathan Fraim, PA
• Lauren Frampton
• Leah Ann Franks, PA-C
• Barbara Lynn Fraser

• Emergency Medicine Physician in Salem, VA
• Providers in Salem, VA by specialty
• Emergency Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.