JODY FORMAN, MSW, L.AC., PLLC (CHARLOTTESVILLE HEALING ARTS) - NPI NUMBER 1316243314

Summary

Provider Name: JODY FORMAN, MSW, L.AC., PLLC (CHARLOTTESVILLE HEALING ARTS)

NPI Number: 1316243314

Clasification: Acupuncturist (171100000X)

Address:
355 WEST RIO RD
SUITE 206A
CHARLOTTESVILLE, VA
ZIP 22901

Phone Number: (434) 975-0025



Detailed Information

JODY FORMAN, MSW, L.AC., PLLC is an acupuncturist in Charlottesville, VA. The provider is an acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. The assigned NPI number for this provider is 1316243314 and is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Charlottesville Healing Arts.

The provider's business address is:

355 WEST RIO RD
SUITE 206A
CHARLOTTESVILLE, VA
ZIP 22901-362
Phone: (434) 975-0025

The provider's authorized official is Jody Forman .
The authorized official title is Licensed Acupuncturist and has the following contact phone number (434) 975-0025.

The enumeration date for this NPI number is 2/8/2011 and was last updated on 2/8/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 171100000X Acupuncturist 0121000011 VA Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1316243314 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name JODY FORMAN, MSW, L.AC., PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name CHARLOTTESVILLE HEALING ARTS Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 5 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 355 WEST RIO RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE 206A The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name CHARLOTTESVILLE The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name VA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 229011362 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 4349750025 The telephone number associated with the location address of the provider being identified.
14 Provider Enumeration Date 2/8/2011 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 2/8/2011 The date that a record was last updated or changed.
16 Authorized Official Last Name FORMAN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name JODY The first name of the authorized official.
18 Authorized Official Title or Position LICENSED ACUPUNCTURIST The title or position of the authorized official.
19 Authorized Official Telephone Number 4349750025 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 171100000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 0121000011 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 VA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Is Organization Subpart N
25 Authorized Official Name Prefix Text MS.
26 Authorized Official Credential Text MSW.,L.AC., PLLC
27 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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