Individual provider Active NPI

Diane Osborne, LCSW

  • Social Worker
  • Fairfax, VA
National Provider Identifier
1013916402
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
0904003453 Issued in VA
Practice address
8500 Executive Park Ave
Suite 200
Fairfax, VA 22031-2225
Phone
(703) 698-5220
Fax
(703) 573-2351
NPI assigned
Jul 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 0904003453 VA Primary

Addresses

Primary practice location

8500 Executive Park Ave
Suite 200
Fairfax, VA 22031-2225

Mailing address

8500 Executive Park Ave
Suite 200
Fairfax, VA 22031-2225
Phone (703) 698-5220

Other identifiers 6

IdentifierTypeStateIssuer
2160262OtherMAMSI
513449OtherVANCPPO
0063OtherDCCAREFIRST DC
7286105OtherAETNA
119079OtherVAANTHEM
231593-000OtherVAMAGELLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040928001290 DC Practitioner - Clinical Social Worker 4486623279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Neuropsych Wellness Center, PCGroup PAC ID 9335271725, 22 clinicians

Practice addresses (Care Compare)

3930 Pender Dr
Suite 240
Fairfax, VA 22030-0986
Phone (703) 865-8686

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904003453VAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Virginia Psychiatric Group CurrentSince Mar 12, 2012 Accepting new patients
Neuropsych Wellness Center, PC CurrentSince Sep 18, 2023 Accepting new patients

Locations

3930 Pender Dr
Ste 240
Fairfax, VA 22030
Phone (703) 865-8686

3930 Pender Dr
Ste 350
Fairfax, VA 22030
Phone (703) 865-6565

8500 Executive Park Ave
Ste 200
Fairfax, VA 22031
Phone (703) 698-5200

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320883200000",
    "number": "1013916402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8500 EXECUTIVE PARK AVE",
            "address_2": "SUITE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312225",
            "telephone_number": "703-698-5220",
            "fax_number": "703-573-2351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 EXECUTIVE PARK AVE",
            "address_2": "SUITE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312225",
            "telephone_number": "703-698-5220",
            "fax_number": "703-573-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSBORNE",
        "first_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2011-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "VA",
            "license": "0904003453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "2160262",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO",
            "identifier": "513449",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST DC",
            "identifier": "0063",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7286105",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "119079",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "231593-000",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.