NPIMap

Organization Active NPI

Mednovations LLC

  • Primary Care Clinic/Center
  • Woodbridge, VA
National Provider Identifier
1013402593
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MEDNOVATIONS LLC
Practice address
1712 Financial Loop
Woodbridge, VA 22192-2459
Phone
(571) 989-4134
NPI assigned
Jun 26, 2018
Last updated
Jun 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Authorized official

Name
Chantal D Lewis, MDNPI 1487817466
Title
Owner
Phone
(301) 254-9444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1712 Financial Loop
Woodbridge, VA 22192-2459

Mailing address

13010 Smoketown Rd
Woodbridge, VA 22192-3367
Phone (301) 254-9444

Other identifiers 1

IdentifierTypeStateIssuer
1487817466MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180910002376 VA Part B Supplier - Clinic/Group Practice 8426308628 Receives reassigned benefits from 5 practitioners
Practice locations: Woodbridge, VA
O20190807002877 DC Part B Supplier - Clinic/Group Practice 8426308628 Receives reassigned benefits from 2 practitioners
Practice locations: Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

1712 Financial Loop
Woodbridge, VA 22192
Phone (571) 989-4134

3122 Golansky Blvd
Woodbridge, VA 22192

3122 Golansky Blvd
Ste 101
Woodbridge, VA 22192
Phone (571) 989-4134

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1013402593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13010 SMOKETOWN RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923367",
            "telephone_number": "301-254-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 FINANCIAL LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922459",
            "telephone_number": "571-989-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDNOVATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "CHANTAL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-254-9444",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487817466",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.