Mina Marie Demarco, D.O.
Individual provider Active NPI Family Medicine Physician · Bristow, VA
NPI 1013203546 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1013203546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0102203773 (VA)
- Practice address
- 10322 Bristow Center Dr
Bristow, VA 20136-2201 - Phone
- (571) 284-4230
- NPI assigned
- Jun 23, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Sports Medicine
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Uva Community Health Medical Group LLC
Legacy Healthcare Services Inc
Practice addresses (Care Compare)
10322 Bristow Ctr Dr
Bristow, VA 20136-2201
Phone (571) 261-3270
9642 Burke Lake Rd
Burke, VA 22015-3052
Phone (703) 543-7920
Hospital & facility affiliations
- Uva Health Prince William Medical Center
- Uva Health Haymarket Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210506000194 | VA | Practitioner - Sports Medicine |
3779730833 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Uva Community Health Medical Group, LLC | Current |
Accepting new patients | |
| Uva Community Health Medical Group, LLC | Current |
Accepting new patients | |
| Uva Community Health Medical Group, LLC | Family Medicine | Past | Accepting new patients |
Locations
10322 Bristow Center Dr
Bristow, VA 20136
Phone (571) 284-4230
4105 Lewis and Clark Dr
Charlottesvle, VA 22911
8640 Sudley Rd
Ste 203
Manassas, VA 20110
Phone (703) 368-3161
Interoperability endpoints
- mdemarco881078@direct.novanthealth.org
- mdemarco516985@direct.healthsystem.virginia.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0102203773 | VA | Yes |
Addresses
Primary practice location
10322 Bristow Center Dr
Bristow, VA 20136-2201
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other practice location 1
3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100
Other practice location 2
8640 Sudley Rd Ste 203
Manassas, VA 20110-4404
Phone (703) 368-3161
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100046947 | Medicaid | WI |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mdemarco881078@direct.novanthealth.org |
Other providers in Bristow, VA
- Rachael Dailey
- Merissa Daniels
- Christiana Odoom Darko
- Christina Day
- Alexandra Delaroderie
- Dentists of Bristow
- Claudine H Desamours
- Mindy Diepenbrock
- Tam Dinh
- Gifty Doku
All providers in Bristow, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.