Individual provider Active NPI

Octavian Cornel Munteanu

  • Physician Assistant
  • Ashburn, VA
National Provider Identifier
1104587351
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110009021 Issued in VA
Practice address
20405 Graceford Ter
Ashburn, VA 20147-5616
Phone
(571) 212-4931
NPI assigned
Jan 9, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110009021 VA Primary

Addresses

Primary practice location

20405 Graceford Ter
Ashburn, VA 20147-5616

Mailing address

20405 Graceford Ter
Ashburn, VA 20147-5616
Phone (571) 212-4931

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
I20230911001767 DC Practitioner - Physician Assistant 5294199253 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
91.67 of 100Reported as group
Quality
90.2
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110009021VAMDPhysician Assistant

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1641686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1104587351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20405 GRACEFORD TER",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475616",
            "telephone_number": "571-212-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20405 GRACEFORD TER",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475616",
            "telephone_number": "571-212-4931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNTEANU",
        "first_name": "OCTAVIAN",
        "middle_name": "CORNEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-09",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashburn, VA

Sources for this page

Verify at the official NPI Registry.