Organization Active NPI

Specialty Physicians of Northern Virginia, LLC

  • Surgery Physician
  • Dulles, VA
National Provider Identifier
1114157054
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SPECIALTY PHYSICIANS OF NORTHERN VIRGINIA, LLC
Practice address
24430 Stone Springs Blvd
Dulles, VA 20166-2267
Phone
(703) 665-2430
NPI assigned
Jul 24, 2009
Last updated
Nov 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Authorized official

Name
Suzanne Bergamo
Title
VP
Phone
(804) 267-5950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

24430 Stone Springs Blvd
Dulles, VA 20166-2267

Mailing address

2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 373-7406

Other identifiers 1

IdentifierTypeStateIssuer
1114157054MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091021000043 DC Part B Supplier - Clinic/Group Practice 6709923915 Receives reassigned benefits from 10 practitioners
Practice locations: Alexandria, VA; Reston, VA; Reston, DC; Fairfax, VA; Arlington, VA
O20110923000130 VA Part B Supplier - Clinic/Group Practice 6709923915 Receives reassigned benefits from 4 practitioners
Practice locations: Berryville, VA; Dulles, VA; Gainesville, VA; Leesburg, VA; Sterling, VA; Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

1429 N Quincy St
Arlington, VA 22207
Phone (703) 558-5766

3 E Main St
Berryville, VA 22611
Phone (540) 955-5051

24420 Stone SPGS Blvd
Ste 550
Dulles, VA 20166
Phone (703) 726-1600

24430 Stone Springs Blvd
Ste 300
Dulles, VA 20166
Phone (703) 665-2430

7051 Heathcote Village Way
Ste 145
Gainesville, VA 20155
Phone (703) 665-2430

1850 Town Center Pkwy
Ste 311
Reston, VA 20190
Phone (703) 433-8700

1850 Town Center Pkwy
Ste 331
Reston, VA 20190

1850 Town Center Pkwy
Ste 440
Reston, VA 20190
Phone (703) 435-4320

1850 Town Center Pkwy
Ste 463
Reston, VA 20190
Phone (571) 910-7877

1860 Town Center Dr
Ste 440
Reston, VA 20190
Phone (571) 554-8950

24420 Stone SPGS Blvd 550
Sterling, VA 20166

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1114157054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274692",
            "telephone_number": "615-373-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24430 STONE SPRINGS BLVD",
            "city": "DULLES",
            "state": "VA",
            "postal_code": "201662267",
            "telephone_number": "703-665-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY PHYSICIANS OF NORTHERN VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-24",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "BERGAMO",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "804-267-5950"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114157054",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dulles, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; 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.