Active NPI
Peter L Passero, DDS
- Periodontics
- MC Lean, VA
National Provider Identifier
1194169565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401005265
- Practice address
- 1430 Spring Hill Rd
MC Lean, VA 22102-3000 - Phone
- (703) 821-4040
- Fax
- (703) 821-4041
- NPI assigned
- Apr 29, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401005265 | VA | Primary |
Addresses
Primary practice location
1430 Spring Hill Rd
MC Lean, VA 22102-3000
Mailing address
1430 Spring Hill Rd
MC Lean, VA 22102-3000
Phone (703) 821-4040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 6, 2013 through Jun 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401005265 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367193600000",
"number": "1194169565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 SPRING HILL RD",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221023000",
"telephone_number": "703-821-4040",
"fax_number": "703-821-4041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 SPRING HILL RD",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221023000",
"telephone_number": "703-821-4040",
"fax_number": "703-821-4041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSERO",
"first_name": "PETER",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-29",
"last_updated": "2013-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401005265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.