NPIMap

Organization Active NPI

Fredericksburg Area Health and Support Services

  • Family Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1104170398
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
Practice address
10514 Wakeman Dr
Fredericksburg, VA 22407-8040
Phone
(540) 907-4555
Fax
(833) 918-2314
NPI assigned
Nov 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Mr. Joseph Lyttle
Title
Executive Director
Phone
(540) 907-4555

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X
Case Management Agency 251B00000X
Public Health or Welfare Agency 251K00000X
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0808X
Adult Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SA2200X
Family Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SF0001X
Adult Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0809X

Addresses

Primary practice location

10514 Wakeman Dr
Fredericksburg, VA 22407-8040

Mailing address

4343 Plank Rd Ste 100
Fredericksburg, VA 22407-4807
Phone (540) 907-4555

Other practice location 1

4343 Plank Rd Ste 110
Fredericksburg, VA 22407-4807
Phone (540) 907-4555

Other practice location 2

219 E Davis St Ste 100
Culpeper, VA 22701-3005
Phone (540) 907-4555

Other practice location 3

415 Elm St
Fredericksburg, VA 22401-3313
Phone (540) 907-4555

Other names 1

  • Mosaic Care Center Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address crystal.miller-williams.2@20704.direct.athenahealth.com Direct
Direct Messaging Address mosaic.care.center.1@20704.direct.athenahealth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200828001684 VA Part B Supplier - Clinic/Group Practice 8628495116 Receives reassigned benefits from 4 practitioners
Practice locations: Fredericksburg, VA

National Provider Directory

National Provider Directory
Tax ID family
Fredericksburg Area Hivaids Support Services Fahass3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

219 E Davis St
Ste 100
Culpeper, VA 22701
Phone (540) 729-8892

4701 Market St
Ste B
Fredericksburg, VA 22408

Interoperability endpoints

  • Direct secure messaging: crystal.miller-williams.2@20704.direct.athenahealth.com

Practitioners & affiliated clinicians

Practitioners 4

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": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1104170398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 PLANK RD STE 100",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224074807",
            "telephone_number": "540-907-4555",
            "fax_number": "540-907-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10514 WAKEMAN DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224078040",
            "telephone_number": "540-907-4555",
            "fax_number": "833-918-2314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4343 Plank Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224074807",
            "country_code": "US",
            "telephone_number": "540-907-4555",
            "fax_number": "540-907-4318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "219 E Davis St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Culpeper",
            "state": "VA",
            "postal_code": "227013005",
            "country_code": "US",
            "telephone_number": "540-907-4555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "415 Elm St",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224013313",
            "country_code": "US",
            "telephone_number": "540-907-4555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "LYTTLE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "540-907-4555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crystal.miller-williams.2@20704.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Crystal Miller-Williams, NP",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10514 Wakeman Dr",
            "city": "Fredericksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "224078040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mosaic.care.center.1@20704.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Medical Services",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10514 Wakeman Dr",
            "city": "Fredericksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "224078040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mosaic Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.