Organization Active NPI

Virginia Retina Center LLC

  • Ophthalmology Physician
  • Warrenton, VA
National Provider Identifier
1093869976
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
01011233782 Issued in VA
Legal business name
VIRGINIA RETINA CENTER LLC
Practice address
45 N Hill Dr Ste 202
Warrenton, VA 20186-2677
Phone
(540) 349-1882
Fax
(703) 738-7157
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Authorized official

Name
Joanne Mansour
Title
Practice Manager
Phone
(540) 349-1882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 01011233782 VA Primary

Addresses

Primary practice location

45 N Hill Dr Ste 202
Warrenton, VA 20186-2677

Mailing address

45 N Hill Dr Ste 202
Warrenton, VA 20186-2677
Phone (540) 349-1882

Other identifiers 2

IdentifierTypeStateIssuer
010107024MedicaidVA
010107067MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041216000232 VA Part B Supplier - Clinic/Group Practice 9335106814 Receives reassigned benefits from 5 practitioners
Practice locations: Falls Church, VA; Warrenton, VA; Sterling, VA; Leesburg, VA; Culpeper, 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
49D2130787Virginia Retina Center45 North Hill Drive - Suite 202, Warrenton, VA 20186Certificate of waiverMay 16, 2027

National Provider Directory

National Provider Directory

Locations

18462 Crossroad Pkwy
Culpeper, VA 22701
Phone (703) 443-0015

19500 Sandridge Way
Ste 240
Leesburg, VA 20176
Phone (703) 443-0015

45 N Hill Dr
Warrenton, VA 20186
Phone (540) 347-0180

Interoperability endpoints

  • Direct secure messaging: msingh@vrc.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 7

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1093869976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 N HILL DR STE 202",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862677",
            "telephone_number": "540-349-1882",
            "fax_number": "703-738-7157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 N HILL DR STE 202",
            "city": "WARRENTON",
            "state": "VA",
            "postal_code": "201862677",
            "telephone_number": "540-349-1882",
            "fax_number": "703-738-7157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA RETINA CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "540-349-1882"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "01011233782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010107024",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010107067",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warrenton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; 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.