Individual provider Active NPI

Catherine Anne Thal-Larsen, F.N.P.

  • Family Nurse Practitioner
  • Gainesville, VA
National Provider Identifier
1174774871
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0017000751 Issued in VA
Practice address
14535 John Marshall Hwy, Suite 212,
Gainesville, VA 20155-4025
Phone
(571) 248-0245
Fax
(571) 248-0241
NPI assigned
Oct 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0017000751 VA Primary

Addresses

Primary practice location

14535 John Marshall Hwy, Suite 212,
Gainesville, VA 20155-4025

Mailing address

224 D Cornwall Street NW
Ste 403
Leesburg, VA 20176-2704
Phone (703) 737-6010

Other identifiers 2

IdentifierTypeStateIssuer
1174774871MedicaidVA
30017620550001MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130606000028 DC Practitioner - Nurse Practitioner 1153574686 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0017000751VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Loudoun Medical Group, PC Current Accepting new patients

Locations

6355 Walker Ln
Ste 308
Alexandria, VA 22310
Phone (703) 313-7700

224D Cornwall St NW
Ste 403
Leesburg, VA 20176
Phone (703) 737-6001

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1174774871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 D CORNWALL STREET NW",
            "address_2": "STE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14535 JOHN MARSHALL HWY, SUITE 212,",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201554025",
            "telephone_number": "571-248-0245",
            "fax_number": "571-248-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAL-LARSEN",
        "first_name": "CATHERINE",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0017000751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174774871",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017620550001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, VA

Sources for this page

Verify at the official NPI Registry.