Organization Active NPI

Michelle a. Rivera MD PC

  • Dermatology Physician
  • Arlington, VA
National Provider Identifier
1174633804
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
0101039759 Issued in VA
Legal business name
MICHELLE A. RIVERA MD PC
Practice address
1635 N George Mason Drive
Suite 400
Arlington, VA 22205
Phone
(703) 524-7206
Fax
(703) 524-7245
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Authorized official

Name
Michelle A Riveria, MD
Title
President
Phone
(703) 524-7206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 0101039759 VA Primary

Addresses

Primary practice location

1635 N George Mason Drive
Suite 400
Arlington, VA 22205

Mailing address

1635 N George Mason Drive
Suite 400
Arlington, VA 22205
Phone (703) 524-7206

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100414000512 DC Part B Supplier - Clinic/Group Practice 0547397044 Receives reassigned benefits from 1 practitioner
Practice locations: Arlington, VA

National Provider Directory

National Provider Directory

Locations

1635 N George Mason Dr
Ste 400
Arlington, VA 22205
Phone (703) 524-7206

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1174633804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N GEORGE MASON DRIVE",
            "address_2": "SUITE 400",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "22205",
            "telephone_number": "703-524-7206",
            "fax_number": "703-524-7245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 N GEORGE MASON DRIVE",
            "address_2": "SUITE 400",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "22205",
            "telephone_number": "703-524-7206",
            "fax_number": "703-524-7245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE A. RIVERA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "RIVERIA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-524-7206",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101039759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.