NPIMap

Individual provider Active NPI

Odyzza Jane Centro, PA-C

  • Physician Assistant
  • Fairfax, VA
National Provider Identifier
1104583947
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110008245 Issued in VA
Practice address
8081 Innovation Park Dr Ste 500
Fairfax, VA 22031-4867
Phone
(571) 472-7040
Fax
(571) 472-7041
NPI assigned
Nov 28, 2021
Last updated
Mar 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0008268 MD
Physician Assistant 363A00000X 0110008245 VA Primary

Addresses

Primary practice location

8081 Innovation Park Dr Ste 500
Fairfax, VA 22031-4867

Mailing address

121 Congressional LN Ste 409
Rockville, MD 20852-1542
Phone (301) 881-0230

Other practice location 1

121 Congressional Ln Ste 409
Rockville, MD 20852-1542
Phone (301) 881-0230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230621003531 DC Practitioner - Physician Assistant 9830557917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

3300 Gallows Rd
Falls Church, VA 22042-3307

8081 Innovation Park Dr
Fairfax, VA 22031-4867

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.36 of 100Reported as group
Quality
73.03
Promoting interoperability
100
Improvement activities
40
Cost
71.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C0008268MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Health Care Services CurrentSince May 8, 2023 Accepting new patients
Inova Health Care Services CurrentSince May 8, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

8081 Innovation Park Dr
#500
Fairfax, VA 22031
Phone (571) 472-7040

8081 Innovation Park Dr
Ste 500
Fairfax, VA 22031
Phone (571) 472-7040

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

Interoperability endpoints

  • Direct secure messaging: ocentro1125069@soc.inova.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1638057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1104583947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CONGRESSIONAL LN STE 409",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521542",
            "telephone_number": "301-881-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8081 INNOVATION PARK DR STE 500",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314867",
            "telephone_number": "571-472-7040",
            "fax_number": "571-472-7041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Congressional Ln Ste 409",
            "address_purpose": "LOCATION",
            "city": "Rockville",
            "state": "MD",
            "postal_code": "208521542",
            "country_code": "US",
            "telephone_number": "301-881-0230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CENTRO",
        "first_name": "ODYZZA",
        "middle_name": "JANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-28",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0008268",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110008245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.