NPIMap

Organization Active NPI

NMG Affiliate Practice I, LLC

Doing business as Novant Health Prince William Cardiology

  • Cardiovascular Disease Physician
  • Manassas, VA
National Provider Identifier
1154701878
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
NMG AFFILIATE PRACTICE I, LLC
Doing business as
Novant Health Prince William Cardiology
Practice address
8567 Sudley Rd Ste B
Manassas, VA 20110-3865
Phone
(703) 369-5959
Fax
(703) 369-7473
NPI assigned
Jun 8, 2015
Last updated
Jun 8, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

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

Authorized official

Name
Geoffery K Gardner
Title
VP of Finance
Phone
(704) 384-7606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X

Addresses

Primary practice location

8567 Sudley Rd Ste B
Manassas, VA 20110-3865

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (703) 369-5959

Other names 1

  • Novant Health Prince William Cardiology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110311000151 VA Part B Supplier - Clinic/Group Practice 4688587967 Receives reassigned benefits from 608 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Manassas, VA; Haymarket, VA; Keswick, VA; Prince William, VA; Richmond, VA; South Riding, VA; Warrenton, VA; Winchester, VA…

National Provider Directory

National Provider Directory
Tax ID family
VA Community Health Medical Group LLC42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Locations

8567 Sudley Rd
Ste B
Manassas, VA 20110
Phone (703) 369-5959

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433721600000",
    "number": "1154701878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "703-369-5959",
            "fax_number": "703-369-7473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8567 SUDLEY RD STE B",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201103865",
            "telephone_number": "703-369-5959",
            "fax_number": "703-369-7473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NMG AFFILIATE PRACTICE I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2015-06-08",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFERY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-7606"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Prince William Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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.