Individual ProviderTimothy J RathbunNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Timothy J Rathbun does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1083624548Provider TypeIndividualFull NameRathbun, Timothy JTitleMr.CredentialCRNAGenderMaleSole ProprietorNoEnumeration Date8/8/2006Last Updated3/30/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 295-9360Fax(703) 295-9369Mailing LocationMailing Address3998 Fair Ridge Dr, Suite 300, Fairfax, VA 22033-2907Phone(703) 295-9360Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024071653VirginiaProvider IdentifiersIDDescriptionIssuerID484645DescriptionOtherIssuerNCPPOVirginiaIDK142-0002DescriptionOtherIssuerCAREFIRSTDistrict of ColumbiaID139180DescriptionOtherIssuerANTHEMVirginiaID300654DescriptionOtherIssuerAMERIGROUPVirginiaID1083624548DescriptionMedicaidIssuerUnlistedVirginiaID430039669DescriptionOtherIssuerRAILROAD MEDICAREVirginia