Basic Information
| Provider Information | |||||||||
| NPI: | 1922031442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH AMERICAN PARTNERS IN ANESTHESIA (VIRGINIA), LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | FAIR OAKS ANESTHESIA ASSOCIATES LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 68 S SERVICE RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | MELVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117472358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169453000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3600 JOSEPH SIEWICK DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033913600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BALL | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7032939590 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 296222 | 01 | VA | ANTHEM BLUE CROSS | OTHER | 1016812 | 01 | VA | WEST VA WORKMANS COMP. | OTHER | K142 | 01 | VA | CARE FIRST DC | OTHER | CD4093 | 01 | VA | RAILROAD MEDICARE | OTHER | 139180 | 01 | VA | ANTHEM BLUE CROSS | OTHER | 139698 | 01 | VA | ANTHEM BLUE CROSS | OTHER | 183998 | 01 | VA | BLUE CROSS OF TN | OTHER | 532655 | 01 | VA | AETNA HMO | OTHER | 144075 | 01 | VA | ANTHEM | OTHER | 139230 | 01 | VA | ANTHEM BLUE CROSS | OTHER | 144077 | 01 | VA | ANTHEM | OTHER | 228769 | 01 | VA | MAMSI UNITED HEALTH CARE | OTHER | 8560960 | 01 | VA | AETNA PPO | OTHER | 9554335 | 05 | VA | MEDICAID | 145768100 | 01 | VA | DEPT. OF LABOR | OTHER |