NPIMap

Organization Active NPI

Loudoun Community Health Center

Doing business as HealthWorks for Northern Virginia

  • Federally Qualified Health Center (FQHC)
  • Reston, VA
National Provider Identifier
1174086938
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOUDOUN COMMUNITY HEALTH CENTER
Doing business as
HealthWorks for Northern Virginia
Practice address
11484 Washington PLZ W Ste 300
Reston, VA 20190-4342
Phone
(703) 443-2000
NPI assigned
Apr 9, 2019
Last updated
Apr 9, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
LOUDOUN COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

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

Authorized official

Name
Robine K Hardey
Title
Cfo
Phone
(703) 443-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

11484 Washington PLZ W Ste 300
Reston, VA 20190-4342

Mailing address

163 Fort Evans Rd NE
Leesburg, VA 20176-4420
Phone (703) 840-4707

Other names 1

  • HealthWorks for Northern Virginia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190919003271 VA Part A Provider - Federally Qualified Health Center (FQHC) 5193822930 Practice locations: Reston, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174086938. Details of each certification follow.

Federally qualified health center certification: CCN 491967

Legal name
LOUDOUN COMMUNITY HEALTH CENTER
Doing business as
HEALTHWORKS RESTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2019
Last certification
Aug 6, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 19, 2004 in VA
Enrollment address
11484 Washington PLZ W
Ste 300
Reston, VA 20190-4342

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Loudoun Comm HLTH Ctr4 organizations share this tax ID, including this one
Part of
Loudoun Comm HLTH Ctr

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jose Alvarez Individual Corporate Director Nov 14, 2017
Harry Bailey Individual Corporate Director Oct 7, 2014
United Bankshares Inc Organization, Leesburg, VA Financial institution 5% Or Greater Mortgage Interest Aug 5, 2014 28%
Sharon Brodeur Individual Corporate OfficerTreasurer Mar 1, 2019
Corporate Director Sep 1, 2018
Kimberly Wagner Individual Corporate OfficerVice President Mar 1, 2019
Corporate Director May 17, 2016
Bettie Baca Individual Corporate Director Jun 1, 2019
Cesar Rodriguez Individual Corporate Director Feb 4, 2014
Ronald Rubin Individual Corporate Director Aug 15, 2017
Susan Lumsden Individual Corporate OfficerPresident Jan 1, 2019
Corporate Director Aug 15, 2017
Carol Jameson Individual Corporate OfficerCeo Feb 19, 2014 100%
W-2 Managing EmployeeCeo Feb 19, 2014 100%

NPI Registry JSON

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1174086938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS RD NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764420",
            "telephone_number": "703-840-4707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11484 WASHINGTON PLZ W STE 300",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904342",
            "telephone_number": "703-443-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOUDOUN COMMUNITY HEALTH CENTER",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "HARDEY",
        "authorized_official_first_name": "ROBINE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "703-443-2000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthWorks for Northern Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.