Orthovirginia, Inc.
Organization Active NPI Multi-Specialty Clinic/Center · MC Lean, VA
NPI 1154946093 · NPPES record last updated Jun 3, 2022
Key facts
- NPI
- 1154946093
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- ORTHOVIRGINIA, INC.
- Practice address
- 1760 Old Meadow Rd Ste 500
MC Lean, VA 22102-4306 - Phone
- (703) 810-5217
- Fax
- (703) 810-5475
- NPI assigned
- Jun 16, 2020
- Organization subpart
- No
Authorized official
- Name
- Nicole Proffitt
- Title
- Credentialing & Enrollment
- Phone
- (804) 533-2357
Other NPIs on the same Medicare enrollment 21
Corporate family (same tax ID) 21
Practitioners 9
-
Dean R Freitas, FNP
-
Laura Oxford, PA-C
-
Reena Patel, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150102000273 | DC | Part B Supplier - Clinic/Group Practice | 0547157224 |
Receives reassigned benefits from 252 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Alexandria, VA; Reston, VA; McLean, VA; MC Lean, VA; Herndon, VA; Fairfax, VA; Burke, VA; Arlington, VA |
| O20200805002152 | VA | DME Supplier - Multi-Specialty - Physician |
0547157224 | Practice locations: MC Lean, VA |
National Provider Directory
- Tax ID family
- Orthovirginia
Locations
6354 Walker Ln
Ste 300
Alexandria, VA 22310
Phone (703) 810-5210
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
1760 Old Meadow Rd Ste 500
MC Lean, VA 22102-4306
Mailing address
PO Box 715868
Philadelphia, PA 19171-5868
Phone (804) 915-1910
Other providers in MC Lean, VA
- Oyuntsetseg Olombayar
- Imaabasi Oloruntoba
- Mosun Olusanya
- Kendra B Omisakin
- Katlynn Opdyke
- Orthovirginia, Inc.
- Kelly Orvin
- Nathalia Ossio Reque
- Sarah L Ouwerkerk
- Dylan Owens
All providers in MC Lean, VA · Multi-Specialty Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.