NPIMap

Organization Active NPI

USA Vein Clinics of Chantilly LLC

  • Vascular Surgery Physician
  • Chantilly, VA
National Provider Identifier
1124670930
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
USA VEIN CLINICS OF CHANTILLY LLC
Practice address
3914 Centreville Rd Ste 125
Chantilly, VA 20151-3289
Phone
(847) 593-8460
Fax
(224) 235-4652
NPI assigned
Jul 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Ami Almeda
Title
Credentialing Manager
Phone
(224) 318-0118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

3914 Centreville Rd Ste 125
Chantilly, VA 20151-3289

Mailing address

304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 593-8460

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200325001981 DC Part B Supplier - Clinic/Group Practice 6406284462 Receives reassigned benefits from 7 practitioners
Practice locations: Chantilly, VA; Fairfax, VA; Vienna, VA
O20230309002871 VA Part B Supplier - Clinic/Group Practice 6406284462 Receives reassigned benefits from 6 practitioners
Practice locations: Arlington, VA; Sterling, VA

National Provider Directory

National Provider Directory

Locations

44110 Ashburn Shopping Plz
Unit 211
Ashburn, VA 20147

11350 Random Hills Rd
Ste 440
Fairfax, VA 22030
Phone (571) 222-5318

11350 Random Hills Rd
Ste 440C
Fairfax, VA 22030
Phone (703) 879-0562

14 Pidgeon Hill Dr
Ste 260C
Sterling, VA 20165
Phone (571) 313-3771

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1124670930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WAINWRIGHT DR",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621900",
            "telephone_number": "847-593-8460",
            "fax_number": "224-235-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 CENTREVILLE RD STE 125",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201513289",
            "telephone_number": "847-593-8460",
            "fax_number": "224-235-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USA VEIN CLINICS OF CHANTILLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "ALMEDA",
        "authorized_official_first_name": "AMI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "224-318-0118"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.