NPIMap

Organization Active NPI

Mount Vernon Rehabilitation Medicine Associates

  • Physical Medicine & Rehabilitation Physician
  • Alexandria, VA
National Provider Identifier
1023063112
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
MOUNT VERNON REHABILITATION MEDICINE ASSOCIATES
Practice address
2501 Parkers LN
Alexandria, VA 22306-3209
Phone
(703) 664-7568
Fax
(410) 793-0809
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Roger Gisolfi, M.D.NPI 1447205513
Title
Chairman
Phone
(703) 664-7568

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
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X VA Primary

Addresses

Primary practice location

2501 Parkers LN
Alexandria, VA 22306-3209

Mailing address

PO Box 829
Alexandria, VA 22304
Phone (703) 664-7568

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330000147 DC Part B Supplier - Clinic/Group Practice 7214828086 Receives reassigned benefits from 13 practitioners
Practice locations: Alexandria, VA; Fairfax, VA; Falls Church, VA
O20160920000420 VA Part B Supplier - Clinic/Group Practice 7214828086 Receives reassigned benefits from 3 practitioners
Practice locations: Leesburg, VA

National Provider Directory

National Provider Directory

Locations

2501 Parkers Ln
Ste 1G1021
Alexandria, VA 22306
Phone (419) 525-6732

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023063112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 829",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "22304",
            "telephone_number": "703-664-7568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 PARKERS LN",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223063209",
            "telephone_number": "703-664-7568",
            "fax_number": "410-793-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON REHABILITATION MEDICINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GISOLFI",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "703-664-7568",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.