NPIMap

Organization Active NPI

Generations Family Medicine PC

  • Family Medicine Physician
  • Reston, VA
National Provider Identifier
1124239470
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101054571 Issued in VA
Legal business name
GENERATIONS FAMILY MEDICINE PC
Practice address
12040 S Lakes Dr
Ste 190
Reston, VA 20191-1246
Phone
(703) 464-0686
Fax
(703) 464-0698
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Authorized official

Name
Dr. Kevin John Kelleher, MDNPI 1689674202
Title
Medical Director
Phone
(703) 464-0686

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0101054571 VA Primary

Addresses

Primary practice location

12040 S Lakes Dr
Ste 190
Reston, VA 20191-1246

Mailing address

12040 S Lakes Dr
Suite 207
Reston, VA 20191-1246
Phone (703) 464-0686

Other identifiers 1

IdentifierTypeStateIssuer
G00463OtherMEDICARE GROUP NO.

Other names 1

  • Generations Family Practice Doing business as

National Provider Directory

National Provider Directory

Locations

381 Elden St
Ste 100
Herndon, VA 20170

12040 South Lakes Dr
Ste 190
Reston, VA 20191
Phone (703) 464-0686

Practitioners & affiliated clinicians

Practitioners 3

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": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357257600000",
    "number": "1124239470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR",
            "address_2": "SUITE 207",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911246",
            "telephone_number": "703-464-0686",
            "fax_number": "703-464-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR",
            "address_2": "STE 190",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911246",
            "telephone_number": "703-464-0686",
            "fax_number": "703-464-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONS FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2013-01-04",
        "status": "A",
        "authorized_official_last_name": "KELLEHER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "703-464-0686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101054571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NO.",
            "identifier": "G00463",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Generations Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.