Great Falls Geriatric Medicine, LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

GREAT FALLS GERIATRIC MEDICINE, LLC

Practice address

10017 Park Royal Dr
Great Falls, VA 22066-1847

Phone

(703) 947-7377

NPI assigned

Dec 23, 2020

Last updated

Dec 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Carol Reyburn Martin, MDNPI 1134347347

Title

Physician

Phone

(703) 947-7377

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Enrollment records 2

Locations

Practitioners 2

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.

• Carol Reyburn Martin, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Great Falls, VA
  • NPI 1134347347

  DC

  Medicare reassignment NPD Authorized official
• Fernan Lance Pasco Oconer, DPT, RPT

  • Physical Therapist
  • Great Falls, VA
  • NPI 1447935069
  NPD (past)

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608681600000",
    "number": "1164019162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 440",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220660440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10017 PARK ROYAL DR",
            "city": "GREAT FALLS",
            "state": "VA",
            "postal_code": "220661847",
            "telephone_number": "703-947-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT FALLS GERIATRIC MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "REYBURN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "703-947-7377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0101265405",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frank Fiorenini
• Steven Curtis Frames, D.D.S
• Ryan Galvin, PT, ATC
• Nahid Ghassemi
• Diane Marie Gioioso, L.AC., M.AC.
• Great Falls Medical Center, LLC
• Great Falls Physical Therapy LLC
• Great Falls Wellness, LLC
• William Edward Greygor, RPH
• Emily C Grubel, FNP

• Geriatric Medicine (Internal Medicine) Physician in Great Falls, VA
• Providers in Great Falls, VA by specialty
• Geriatric Medicine (Internal Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; 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.