| NPI Number | 1487110847 |
| Provider Name | Corey Jamal Lott |
| Credential | |
| Specialization | |
| Medical School Name | |
| Graduation Year | |
| Gender | |
| Entity Type | Individual |
| PAC ID by PECOS | |
| Professional Enrollment ID | |
| Enumeration Date | 02/11/2019 |
| Last Update Date | 02/11/2019 |
| Business Practice address |
1604 CAVALIER BLVD, Pontamouth, 23701 Virginia View on Google Map |
| Business Practice phone | 757-297-9086 |
| Business Practice fax | |
| Mailing address |
1604 CAVALIER BLVD, Pontamouth, 23701 Virginia View on Google Map |
| Other phone | 757-297-9086 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Practices in Pontamouth
Pontamouth, Virginia
| Field Name | Field Value |
|---|---|
| NPI | 1487110847 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
|
| Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
|
|
| Provider Last Name (Legal Name) | Lott |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Corey |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 1604 CAVALIER BLVD |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Pontamouth |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Virginia |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 23701 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 757-297-9086 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 1604 CAVALIER BLVD |
| 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. | |
| Provider Business Practice Location Address City Name | Pontamouth |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Virginia |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 23701 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 757-297-9086 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 02/11/2019 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 02/11/2019 |
| The date that a record was last updated or changed. | |
| Healthcare Provider Taxonomy Code #1 | 335G00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet. Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies. |
| Healthcare Provider Taxonomy #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 374T00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | Religious nonmedical nursing personnel are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical needs such as assistance with activities of daily living; assistance with moving, positioning, and ambulation; nutritional needs; and comfort and support measures. |
| Healthcare Provider Taxonomy #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 347E00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | An organization that provides transportation for individuals who need access to medical care or services and have no other means of transportation. Transportation includes, but is not limited to, wheelchair van, taxi, stretcher car, bus passes and tickets, and secured transportation. |
| Healthcare Provider Taxonomy #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 372600000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | An individual who provides supervision, socialization, and non-medical care to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. These services are provided in accordance with a therapeutic goal in the plan of care. |
| Healthcare Provider Taxonomy #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #5 | 3747P1801X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Healthcare Provider Taxonomy #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #6 | 374K00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 6 | A religious nonmedical practitioner offers spiritually-based care. Services may be rendered in an office, home, or care facility or by phone, email, or written correspondence. |
| Healthcare Provider Taxonomy #6 | |
| Healthcare Provider Primary Taxonomy Switch 6 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #7 | 175T00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 7 | Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Healthcare Provider Taxonomy #7 | |
| Healthcare Provider Primary Taxonomy Switch 7 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #8 | 175T00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 8 | Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Healthcare Provider Taxonomy #8 | |
| Healthcare Provider Primary Taxonomy Switch 8 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #9 | 332B00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 9 | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. |
| Healthcare Provider Taxonomy #9 | |
| Healthcare Provider Primary Taxonomy Switch 9 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #10 | 332BP3500X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 10 | Definition to come... |
| Healthcare Provider Taxonomy #10 | |
| Healthcare Provider Primary Taxonomy Switch 10 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #11 | 332BX2000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 11 | Definition to come... |
| Healthcare Provider Taxonomy #11 | |
| Healthcare Provider Primary Taxonomy Switch 11 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #12 | 332BD1200X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 12 | Definition to come... |
| Healthcare Provider Taxonomy #12 | |
| Healthcare Provider Primary Taxonomy Switch 12 | Y |
Primary Taxonomy:
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