Individual provider Active NPI

Mayur Vallabhaneni, MD

  • Emergency Medicine Physician
  • Charlottesville, VA
National Provider Identifier
1164914446
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101272595 Issued in VA
Practice address
1215 Lee St
Charlottesville, VA 22908-0816
Phone
(434) 924-8485
Fax
(434) 982-4118
NPI assigned
Jun 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 0101272595 VA Primary

Addresses

Primary practice location

1215 Lee St
Charlottesville, VA 22908-0816

Mailing address

1215 Lee St Box 800699
Charlottesville, VA 22908-0816
Phone (434) 924-8485

Other practice location 1

4320 Seminary Rd
Alexandria, VA 22304-1535
Phone (240) 686-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211005000457 DC Practitioner - Emergency Medicine 4284982810 Reassigns benefits to 1 organization
I20241119000704 GA Practitioner - Emergency Medicine 4284982810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

1350 Walton Way
Augusta, GA 30901-2612
Phone (706) 774-2165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.52 of 100Reported as group
Quality
91.6
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101272595VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alexandria Springfield Emergency Physicians PC Emergency Medicine CurrentSince Sep 1, 2021 Accepting new patients
Alexandria Springfield Emergency Physicians PC Emergency Medicine CurrentSince Sep 1, 2021 Accepting new patients
Alexandria Springfield Emergency Physicians PC Emergency Medicine Current Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Sep 1, 2024 Accepting new patients

Locations

1350 Walton Way
Augusta, GA 30901
Phone (706) 722-9011

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

12420 Milestone Center Dr
Ste 200
Germantown, MD 20876
Phone (336) 509-7515

4320 Seminary Rd
Alexandria, VA 22304
Phone (703) 504-3000

6355 Walker Ln
Franconia, VA 22310
Phone (703) 664-7453

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1527984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1164914446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 LEE ST BOX 800699",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-8485",
            "fax_number": "434-982-4118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 LEE ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229080816",
            "telephone_number": "434-924-8485",
            "fax_number": "434-982-4118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4320 Seminary Rd",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223041535",
            "country_code": "US",
            "telephone_number": "240-686-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALLABHANENI",
        "first_name": "MAYUR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-03",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101272595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.