Potomac Inova Healthcare Alliance

Primary specialty

Radiation Oncology Clinic/CenterTaxonomy code 261QX0203X

Legal business name

POTOMAC INOVA HEALTHCARE ALLIANCE

Doing business as

Potomac Radiation Oncology Center

Practice address

2296 Opitz Blvd
Suite 140
Woodbridge, VA 22191-3300

Phone

(703) 670-3349

Fax

(703) 580-0730

NPI assigned

Apr 15, 2008

Last updated

Feb 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jackie Mason

Title

Director

Phone

(703) 670-3349

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Potomac Radiation Oncology Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Inova Health Care Services

  dba Inova Mount Vernon Hospital

  • Psychiatric Hospital Unit
  • Alexandria, VA
  • NPI 1104957083

  Member Of

  NPD member
• Potomac Hospital Corporation of Prince William

  dba Sentara Northern Virginia Medical Center

  • General Acute Care Hospital
  • Woodbridge, VA
  • NPI 1548366404

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361836800000",
    "number": "1013181791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 TELESTAR CT",
            "address_2": "SUITE 3PI",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220421207",
            "telephone_number": "571-423-5727",
            "fax_number": "571-423-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2296 OPITZ BLVD",
            "address_2": "SUITE 140",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913300",
            "telephone_number": "703-670-3349",
            "fax_number": "703-580-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC INOVA HEALTHCARE ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2013-02-26",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-670-3349",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "2108004",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2521782",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7154230",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "245110",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007603118",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potomac Radiation Oncology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Potomac Home Care LLC (B&L Caregivers, LLC)
• Potomac Hospital
• Potomac Hospital
• Potomac Hospital Corporation of Prince William
• Potomac Hospital Corporation of Prince William (Sentara Northern Virginia Medical Center)
• Potomac Inova Healthcare Alliance, LLC (Woodbridge CT)
• Potomac Inova Healthcare Alliance, LLC (Woodbridge PET/CT)
• Potomac Internal Medicine,PLLC
• Potomac Mills Family Dental
• Potomac Ophthalmology PC

• Radiation Oncology Clinic/Center in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Radiation Oncology Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.