NPIMap

Organization Active NPI

Glen Allen Medi LLC

  • Family Medicine Physician
  • Glen Allen, VA
National Provider Identifier
1083283832
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLEN ALLEN MEDI LLC
Practice address
11551 Nuckols Rd Ste C
Glen Allen, VA 23059-5565
Phone
(704) 926-7546
NPI assigned
Jun 24, 2021
Last updated
Jul 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Andrew Rhodes
Title
Owner
Phone
(704) 926-7546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

11551 Nuckols Rd Ste C
Glen Allen, VA 23059-5565

Mailing address

11551 Nuckols Rd Ste C
Glen Allen, VA 23059-5565

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
49D2004381Glen Allen Medi LLC11551 Nuckols Road - Suite C, Glen Allen, VA 23059Certificate of waiverMar 2, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1083283832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11551 NUCKOLS RD STE C",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11551 NUCKOLS RD STE C",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595565",
            "telephone_number": "704-926-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ALLEN MEDI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "RHODES",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-926-7546"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.