Individual provider Active NPI

Michael Tesfazion, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Washington, DC
National Provider Identifier
1033311246
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA030331 Issued in DC
Practice address
2041 Georgia Avenue
Washington, DC 20001
Phone
(202) 865-1141
NPI assigned
Jun 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA030331 DC Primary

Addresses

Primary practice location

2041 Georgia Avenue
Washington, DC 20001

Mailing address

18213 Queen Elizabeth Dr
Olney, MD 20832-1717
Phone (301) 366-8606

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100420000165 DC Practitioner - Physician Assistant 9335276591 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Apr 1, 2016 Accepting new patients
Cep America LLC CurrentSince Apr 1, 2016 Accepting new patients
Emergency Medicine Associates, PA CurrentSince May 15, 2015 Accepting new patients
Anacostia River Emergency Physicians LLC Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1150 Varnum St NE
Washington, DC 20017
Phone (202) 269-7000

2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785

Organizations & group practices 7

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": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1033311246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18213 QUEEN ELIZABETH DR",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321717",
            "telephone_number": "301-366-8606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 GEORGIA AVENUE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20001",
            "telephone_number": "202-865-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESFAZION",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DC",
            "license": "PA030331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.