Organization Active NPI

Marshall Family Medicine LLC

  • Family Medicine Physician
  • Marshall, VA
National Provider Identifier
1023767902
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARSHALL FAMILY MEDICINE LLC
Practice address
4197 Winchester Rd
Marshall, VA 20115-3252
Phone
(703) 657-9612
NPI assigned
Mar 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Thuy Lan Thi OlsonNPI 1518182377
Title
Physician/Owner
Phone
(540) 364-8199

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4197 Winchester Rd
Marshall, VA 20115-3252

Mailing address

4197C Winchester Rd
Marshall, VA 20115-3252
Phone (540) 364-8199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220729001805 VA Part B Supplier - Clinic/Group Practice 8628450285 Receives reassigned benefits from 2 practitioners
Practice locations: Marshall, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2264835Marshall Family Medicine4197C Winchester Rd, Marshall, VA 20115Certificate of waiverJul 19, 2028

National Provider Directory

National Provider Directory

Locations

4197 Winchester Rd
Marshall, VA 20115
Phone (703) 657-9612

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1647734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1023767902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4197C WINCHESTER RD",
            "city": "MARSHALL",
            "state": "VA",
            "postal_code": "201153252",
            "telephone_number": "540-364-8199",
            "fax_number": "540-360-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4197 WINCHESTER RD",
            "city": "MARSHALL",
            "state": "VA",
            "postal_code": "201153252",
            "telephone_number": "703-657-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-20",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "THUY LAN",
        "authorized_official_middle_name": "THI",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "540-364-8199"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.