Active NPI 1831641455 Individual Practitioner Male Practitioner

Dr. Prem P. Batchala , MD

Radiology - Nuclear Radiology • Charlottesville, VA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Prem Batchala, MD is a certified Radiology - Nuclear Radiology practicing in Charlottesville, VA. With approximately 25 years of clinical experience since completing medical education in 2001, Dr. Batchala delivers high-quality medical care to the local community at 1215 LEE ST.

Dr. Batchala maintains professional affiliations with University Of Virginia Imaging Llc, University Of Virginia Physicians Group and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, gadoterate meglumine, 0.1 ml, low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml, injection, gadobutrol, 0.1 ml. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1215 Lee St

Charlottesville, VA 229080816

Telephone 4349249400

Fax 4349821618

Associated Practice Facility / Clinic

🏢 Rector & Visitors Of The University Of Virginia Facility NPI 1588633317

Medicare Profile & Education

Medical School

Other

Graduation Year

2001

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Radiology - Nuclear Radiology in Charlottesville, VA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

25 Yrs -10.7 yrs vs City Avg

City Avg: 35.7 Yrs

State Avg: 35.7 Yrs

Regional Practice Density

3 Specialists

Practicing in Charlottesville, VA (12 Statewide)

Telehealth Adoption Rate

33.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

92.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Batchala (25 Years) 25 Yrs

Charlottesville Specialty Average (35.7 Years) 35.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
A9575 Injection, gadoterate meglumine, 0.1 ml	19,290	111	$5.25	$0.12
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	5,660	58	$1.05	$0.13
A9585 Injection, gadobutrol, 0.1 ml	4,575	48	$9.45	$0.30
78815 Nuclear medicine study from skull base to mid-thigh with ct scan	292	280	$330.00	$107.58
70553 Mri scan of brain before and after contrast	266	135	$3454.71	$148.42
78816 Nuclear medicine study whole body with ct scan	98	91	$333.00	$107.68
70551 Mri scan of brain without contrast	95	52	$1804.87	$94.07
70450 Ct scan head or brain without contrast	81	75	$148.00	$37.81
72148 MRI scan of lower spinal canal	81	46	$1724.96	$90.57
70491 CT scan of neck with contrast	68	34	$1509.50	$79.87
70496 Ct scan of blood vessels of head with contrast	60	31	$2071.88	$122.68
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	56	56	$220.00	$71.59
72141 MRI scan of upper spinal canal	53	31	$1773.60	$78.83
70496 Ct scan of blood vessels of head with contrast	52	52	$314.00	$78.96
70498 Ct scan of blood vessels of neck with contrast	52	52	$314.00	$75.59
70498 Ct scan of blood vessels of neck with contrast	47	24	$2095.77	$87.51
78306 Nuclear medicine study of bone and/or joint whole body	47	45	$113.00	$37.66
72156 Mri scan of upper spinal canal before and after contrast	45	23	$4283.71	$121.13
70553 Mri scan of brain before and after contrast	40	39	$409.00	$100.77
72157 Mri scan of middle spinal canal before and after contrast	38	18	$4394.50	$154.40
70544 Mri scan of blood vessels of head without contrast	36	20	$2299.47	$99.48
72158 Mri scan of lower spinal canal before and after contrast	32	16	$4345.00	$120.12
70551 Mri scan of brain without contrast	31	31	$257.00	$66.82
70491 CT scan of neck with contrast	30	30	$239.00	$62.37
70486 CT scan of face	24	12	$2190.50	$63.37
72132 Ct scan of lower spine with contrast	23	23	$170.00	$53.18
72146 Mri scan of middle spinal canal	21	12	$2654.57	$62.67
72148 MRI scan of lower spinal canal	21	21	$207.00	$65.80
70450 Ct scan head or brain without contrast	21	13	$1267.52	$50.39
78832 Nuclear medicine study, spect imaging with concurrent ct scan, at least 2 areas or separate acquisitions, single day imaging, or single area or acquisition over multiple days	20	17	$284.00	$89.86
78608 Nuclear medicine study brain with metabolic evaluation	18	18	$199.00	$64.20
72129 Ct scan of middle spine with contrast	17	17	$170.00	$55.31
78803 Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging	17	17	$146.00	$47.87
78802 Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging	17	17	$110.00	$34.15
72125 Ct scan of upper spine without contrast	16	16	$202.00	$44.81
78195 Imaging of lymphatic tissue and lymph node	16	16	$162.00	$53.00
72126 CT scan of upper spine with contrast	15	15	$211.00	$53.45
78814 Nuclear medicine study limited area with ct scan	14	14	$295.00	$96.82
78830 Nuclear medicine study, spect imaging with concurrent ct scan, 1 area or single acquisition, single day imaging	14	14	$200.00	$64.22
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	14	14	$220.00	$72.25
72141 MRI scan of upper spinal canal	14	14	$207.00	$66.30
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$458.00	$121.87
70486 CT scan of face	11	11	$221.00	$37.94

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
A9575 Injection, gadoterate meglumine, 0.1 ml	20,865	130	$5.25	$0.14
A9585 Injection, gadobutrol, 0.1 ml	4,878	54	$9.45	$0.33
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	3,225	35	$1.05	$0.15
70553 Mri scan of brain before and after contrast	342	172	$3452.11	$157.83
78815 Nuclear medicine study from skull base to mid-thigh with ct scan	264	250	$330.00	$112.66
70450 Ct scan head or brain without contrast	163	158	$148.00	$39.39
78816 Nuclear medicine study whole body with ct scan	95	86	$333.00	$113.17
78306 Nuclear medicine study of bone and/or joint whole body	82	77	$113.00	$38.46
70551 Mri scan of brain without contrast	81	44	$1783.59	$97.31
70553 Mri scan of brain before and after contrast	74	73	$409.00	$108.15
72148 MRI scan of lower spinal canal	68	39	$1756.85	$92.85
70450 Ct scan head or brain without contrast	62	33	$1323.50	$54.71
72156 Mri scan of upper spinal canal before and after contrast	58	29	$4197.50	$135.37
70498 Ct scan of blood vessels of neck with contrast	54	54	$314.00	$79.35
70496 Ct scan of blood vessels of head with contrast	52	52	$314.00	$82.31
70551 Mri scan of brain without contrast	50	50	$257.00	$68.54
70491 CT scan of neck with contrast	46	45	$239.00	$64.78
70491 CT scan of neck with contrast	45	23	$1424.80	$81.31
72157 Mri scan of middle spinal canal before and after contrast	45	23	$4303.91	$162.79
70496 Ct scan of blood vessels of head with contrast	42	22	$2045.90	$128.80
72141 MRI scan of upper spinal canal	42	23	$1840.10	$85.00
70544 Mri scan of blood vessels of head without contrast	41	21	$2476.51	$114.32
70498 Ct scan of blood vessels of neck with contrast	37	20	$1986.89	$90.14
72158 Mri scan of lower spinal canal before and after contrast	34	17	$4345.00	$119.14
72148 MRI scan of lower spinal canal	32	32	$207.00	$70.02
72125 Ct scan of upper spine without contrast	30	30	$202.00	$46.09
79101 Radioactive drug therapy through a vein	28	14	$273.00	$93.76
78803 Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging	26	24	$146.00	$49.91
72146 Mri scan of middle spinal canal	26	14	$3062.50	$71.74
78264 Stomach emptying study	25	25	$108.00	$36.10
70486 CT scan of face	22	12	$2011.45	$64.53
78431 Multiple nuclear medicine studies of blood flow in heart muscle at rest and with stress, with concurrently acquired ct transmission scan	20	20	$257.00	$87.40
78434 Nuclear medicine study of heart muscle blood flow by pet	19	19	$264.00	$29.02
78195 Imaging of lymphatic tissue and lymph node	19	19	$162.00	$53.98
72131 CT scan of lower spine	16	16	$139.00	$45.57
72128 CT scan of middle spine	16	15	$139.00	$45.28
72132 Ct scan of lower spine with contrast	16	16	$170.00	$55.75
70486 CT scan of face	16	16	$221.00	$39.86
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$458.00	$132.09
78582 Nuclear medicine study of lung ventilation and circulation	13	13	$146.00	$49.58
72141 MRI scan of upper spinal canal	13	13	$207.00	$69.59
78227 Nuclear medicine study of liver and bile duct system with use of drugs	13	13	$125.00	$39.66
78832 Nuclear medicine study, spect imaging with concurrent ct scan, at least 2 areas or separate acquisitions, single day imaging, or single area or acquisition over multiple days	13	11	$284.00	$96.98
72129 Ct scan of middle spine with contrast	12	12	$170.00	$56.74
78830 Nuclear medicine study, spect imaging with concurrent ct scan, 1 area or single acquisition, single day imaging	12	12	$200.00	$67.42
72158 Mri scan of lower spinal canal before and after contrast	12	12	$318.00	$105.89
78433 Combined nuclear medicine study of blood flow in heart muscle with metabolic evaluation and concurrently acquired ct transmission scan	11	11	$299.00	$101.60
78608 Nuclear medicine study brain with metabolic evaluation	11	11	$199.00	$68.77
72146 Mri scan of middle spinal canal	11	11	$207.00	$69.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
A9575 Injection, gadoterate meglumine, 0.1 ml	3,470	22	$5.25	$0.14
A9585 Injection, gadobutrol, 0.1 ml	1,006	11	$9.45	$0.34
78815 Nuclear medicine study from skull base to mid-thigh with ct scan	385	347	$330.00	$115.41
78306 Nuclear medicine study of bone and/or joint whole body	131	119	$113.00	$39.86
78816 Nuclear medicine study whole body with ct scan	100	92	$333.00	$116.00
70553 Mri scan of brain before and after contrast	60	31	$3628.87	$164.68
78264 Stomach emptying study	30	30	$108.00	$38.00
78803 Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging	24	23	$146.00	$50.91
78195 Imaging of lymphatic tissue and lymph node	23	23	$162.00	$53.53
78227 Nuclear medicine study of liver and bile duct system with use of drugs	21	21	$125.00	$42.70
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	18	18	$220.00	$77.61
78707 Nuclear medicine study of kidney with assessment of blood flow and function	16	13	$131.00	$45.01
78433 Combined nuclear medicine study of blood flow in heart muscle with metabolic evaluation and concurrently acquired ct transmission scan	15	14	$299.00	$103.13
78431 Multiple nuclear medicine studies of blood flow in heart muscle at rest and with stress, with concurrently acquired ct transmission scan	14	14	$257.00	$90.14
70450 Ct scan head or brain without contrast	13	13	$148.00	$39.99
78434 Nuclear medicine study of heart muscle blood flow by pet	12	12	$264.00	$29.73
78582 Nuclear medicine study of lung ventilation and circulation	12	12	$146.00	$50.92
78315 Nuclear medicine study of bone taken at different times	12	12	$140.00	$48.45

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
78815 Nuclear medicine study from skull base to mid-thigh with ct scan	482	436	$328.21	$116.79
78306 Nuclear medicine study of bone and/or joint whole body	165	156	$113.00	$40.27
78816 Nuclear medicine study whole body with ct scan	129	114	$330.40	$117.69
78803 Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging	53	47	$145.34	$51.34
78707 Nuclear medicine study of kidney with assessment of blood flow and function	37	32	$130.05	$43.84
78582 Nuclear medicine study of lung ventilation and circulation	35	35	$145.00	$51.34
78264 Stomach emptying study	29	28	$107.83	$38.38
78195 Imaging of lymphatic tissue and lymph node	27	27	$161.48	$57.26
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	24	24	$219.08	$77.89
78227 Nuclear medicine study of liver and bile duct system with use of drugs	17	17	$124.65	$43.63
78830 Nuclear medicine study, spect imaging with concurrent ct scan, 1 area or single acquisition, single day imaging	16	16	$198.75	$66.61
78832 Nuclear medicine study, spect imaging with concurrent ct scan, at least 2 areas or separate acquisitions, single day imaging, or single area or acquisition over multiple days	15	15	$280.53	$100.51
78315 Nuclear medicine study of bone taken at different times	13	13	$140.00	$49.23
78802 Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging	12	11	$110.00	$25.59
78431 Multiple nuclear medicine studies of blood flow in heart muscle at rest and with stress, with concurrently acquired ct transmission scan	12	12	$257.00	$90.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
A9585 Injection, gadobutrol, 0.1 ml	5,956	74	$9.00	$0.37
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	1,530	17	$1.00	$0.12
78815 Nuclear medicine study from skull base to mid-thigh with ct scan	256	247	$312.00	$121.83
70553 Mri scan of brain before and after contrast	114	74	$4118.92	$194.40
70553 Mri scan of brain before and after contrast	86	86	$409.00	$116.51
78306 Nuclear medicine study of bone and/or joint whole body	85	84	$112.00	$42.42
70496 Ct scan of blood vessels of head with contrast	76	76	$314.00	$88.38
78816 Nuclear medicine study whole body with ct scan	70	66	$315.00	$123.75
70498 Ct scan of blood vessels of neck with contrast	69	69	$314.00	$85.15
70450 Ct scan head or brain without contrast	49	48	$148.00	$42.77
70551 Mri scan of brain without contrast	46	46	$257.00	$75.01
78803 Nuclear medicine study, spect imaging, 1 area or single acquisition, single day imaging	24	18	$136.00	$54.19
70551 Mri scan of brain without contrast	24	16	$2716.33	$116.96
70544 Mri scan of blood vessels of head without contrast	23	23	$208.00	$60.33
78195 Imaging of lymphatic tissue and lymph node	22	22	$155.00	$58.55
78707 Nuclear medicine study of kidney with assessment of blood flow and function	22	17	$123.00	$48.35
70491 CT scan of neck with contrast	20	11	$1643.50	$85.29
78830 Nuclear medicine study, spect imaging with concurrent ct scan, 1 area or single acquisition, single day imaging	19	19	$183.00	$74.22
78264 Stomach emptying study	17	17	$99.00	$38.66
72158 Mri scan of lower spinal canal before and after contrast	16	16	$301.00	$113.87
72156 Mri scan of upper spinal canal before and after contrast	13	13	$301.00	$114.70
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	12	12	$206.00	$81.52
78452 Nuclear medicine studies of heart muscle at rest and with stress and spect	11	11	$206.00	$81.47
78582 Nuclear medicine study of lung ventilation and circulation	11	11	$138.00	$54.19
70491 CT scan of neck with contrast	11	11	$239.00	$69.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
A9585 Injection, gadobutrol, 0.1 ml	7,527	91	$9.00	$0.35
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	2,100	23	$1.00	$0.11
70553 Mri scan of brain before and after contrast	129	83	$4195.86	$196.26
70553 Mri scan of brain before and after contrast	111	106	$409.00	$112.76
70498 Ct scan of blood vessels of neck with contrast	91	91	$314.00	$83.03
70496 Ct scan of blood vessels of head with contrast	90	90	$314.00	$86.52
70551 Mri scan of brain without contrast	72	70	$257.00	$70.82
70450 Ct scan head or brain without contrast	67	64	$148.00	$41.77
70544 Mri scan of blood vessels of head without contrast	34	34	$208.00	$60.01
70551 Mri scan of brain without contrast	33	22	$2716.33	$119.19
70450 Ct scan head or brain without contrast	31	17	$1306.19	$57.38
70496 Ct scan of blood vessels of head with contrast	25	13	$2266.08	$138.62
70544 Mri scan of blood vessels of head without contrast	21	12	$1937.14	$137.90
72158 Mri scan of lower spinal canal before and after contrast	16	15	$285.81	$107.87
70491 CT scan of neck with contrast	16	15	$239.00	$67.61
70548 Mri scan of blood vessels of neck with contrast	14	14	$208.00	$72.11
72141 MRI scan of upper spinal canal	11	11	$190.09	$73.26

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
70450 Ct scan head or brain without contrast	70	64	$148.00	$41.92
70553 Mri scan of brain before and after contrast	57	55	$586.38	$117.12
70553 Mri scan of brain before and after contrast	39	39	$409.00	$114.00
70498 Ct scan of blood vessels of neck with contrast	30	29	$314.00	$83.68
70551 Mri scan of brain without contrast	27	27	$257.00	$73.84
70496 Ct scan of blood vessels of head with contrast	26	25	$314.00	$86.78
70496 Ct scan of blood vessels of head with contrast	14	14	$314.00	$87.26
70498 Ct scan of blood vessels of neck with contrast	13	13	$314.00	$83.54
70544 Mri scan of blood vessels of head without contrast	11	11	$208.00	$60.13
70450 Ct scan head or brain without contrast	11	11	$148.00	$42.72
70551 Mri scan of brain without contrast	11	11	$257.00	$74.53

Medical Specialties & State Licenses

CMS Verified: 2020-10-19

Radiology - Nuclear Radiology Primary Specialty

NUCC Taxonomy Code: 2085N0904X

State License VA 0101265957

A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease.

Radiology - Diagnostic Radiology

NUCC Taxonomy Code: 2085R0202X

State License VA 0101265957

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Hospital & Practice Group Affiliations

University Of Virginia Physicians Group

661 University Ln, Orange, VA 229602243

University Of Virginia Physicians Group

415 Ray C Hunt Dr, Charlottesville, VA 229032980

University Of Virginia Physicians Group

7901 Lake Manassas Dr, Gainesville, VA 201553257

Phone: 7037534045

University Of Virginia Physicians Group

2965 Ivy Rd, Charlottesville, VA 229039330

Phone: 4342434394

University Of Virginia Physicians Group

2280 Ivy Rd, Charlottesville, VA 229034977

University Of Virginia Physicians Group

500 Ray C Hunt Dr, Charlottesville, VA 229032981

Phone: 4342434520

University Of Virginia Physicians Group

1240 Lee St, Charlottesville, VA 229080817

Phone: 4342430321

University Of Virginia Physicians Group

8700 Sudley Rd, Manassas, VA 201104418

Phone: 7033698073

University Of Virginia Physicians Group

515 Ray C Hunt Dr, Charlottesville, VA 229032981

Phone: 4342442000

University Of Virginia Physicians Group

1215 Lee St, Charlottesville, VA 229080816

University Of Virginia Physicians Group

1015 Spring Creek Pkwy, Zion Crossroads, VA 229427019

Phone: 4342439466

University Of Virginia Physicians Group

501 Sunset Ln, Culpeper, VA 227013917

University Of Virginia Imaging Llc

415 Ray C Hunt Dr, Charlottesville, VA 229032980

Phone: 4342439198

University Of Virginia Physicians Group

545 Ray C Hunt Dr, Charlottesville, VA 229032981

University Of Virginia Physicians Group

2965 Ivy Rd, Charlottesville, VA 229039330

Phone: 4342439198

Secondary Practice Locations

1240 Lee St

Charlottesville, VA 229080817

Phone: 4342436888

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

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Radiology - Diagnostic Radiology

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Doctor of Medicine (M.D.)

Dr. Connor Sleeth , MD

Radiology - Diagnostic Radiology

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Doctor of Medicine (M.D.)

Dr. Olivia Little , MD

Student in an Organized Health Care Education/Training Program

NPI 1003603531

Doctor of Medicine (M.D.)

Megan Kingdon , NP

Nurse Practitioner

NPI 1013212554

Nurse Practitioner

Dr. Kaelin Cockrell , MD

Student in an Organized Health Care Education/Training Program

NPI 1013657386

Doctor of Medicine (M.D.)

Dr. Gia Deangelis , MD

Radiology - Body Imaging

NPI 1023167905

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events

📍

Updated Practice Location October 19, 2020

Registered at 1215 LEE ST, CHARLOTTESVILLE, VA 229080816 (Tel: 4349249400)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 19, 2020

Radiology (License #0101265957 in VA)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 08, 2019

Radiology (License #0101265957 in VA)

✅

NPI Profile Active October 13, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location October 13, 2017

Registered at 1215 LEE ST FL 1, CHARLOTTESVILLE, VA 229080816 (Tel: 4349249400)

📍

Updated Business Mailing Address October 13, 2017

Registered at PO BOX 9007, CHARLOTTESVILLE, VA 229069007

👤

Provider Name / Credentials Updated October 13, 2017

Recorded as PREM BATCHALA, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 13, 2017

Radiology (License #0109542101 in VA)

✅

NPI Profile Active October 31, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location October 31, 2016

Registered at 1215 LEE ST, BOX 800170, CHARLOTTESVILLE, VA 229080816 (Tel: 4349820428)

📍

Updated Business Mailing Address October 31, 2016

Registered at 103 IVY DR APT 1, CHARLOTTESVILLE, CHARLOTTESVILLE, VA 229035004 (Tel: 4342827493)

👤

Provider Name / Credentials Updated October 31, 2016

Recorded as PREM BATCHALA, MBBS

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 31, 2016

Student in an Organized Health Care Education/Training Program (License #0116029946 in VA)

🟢

Initial NPI Registration & Enumeration October 31, 2016

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1831641455

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 31, 2016

Last Update: October 19, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 9007

Charlottesville, VA 229069007

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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