NPIMap

Organization Active NPI

Loudoun Medical Group, PC

Doing business as Advanced ENT Specialist

  • Otolaryngology Physician
  • Leesburg, VA
National Provider Identifier
1215051693
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Doing business as
Advanced ENT Specialist
Practice address
19490 Sandridge Way, Suite 230
Leesburg, VA 20176-3467
Phone
(703) 858-5885
Fax
(703) 858-5001
NPI assigned
Mar 19, 2007
Last updated
Nov 10, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LOUDOUN MEDICAL GROUP, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Authorized official

Name
Mary Beth Tamasy
Title
Ceo
Phone
(703) 737-6010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

19490 Sandridge Way, Suite 230
Leesburg, VA 20176-3467

Mailing address

224D Cornwall St NW Ste 403
Leesburg, VA 20176-2704
Phone (703) 737-6001

Other names 1

  • Advanced ENT Specialist Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041115000474 VA Part B Supplier - Clinic/Group Practice 0042119661 Receives reassigned benefits from 340 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

National Provider Directory

National Provider Directory
Tax ID family
Loudoun Medical Group P305 organizations share this tax ID, including this one
Part of
Loudoun Medical Group P

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

19490 Sandridge Way
Ste 230
Leesburg, VA 20176
Phone (703) 858-5885

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1215051693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224D CORNWALL ST NW STE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6001",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19490 SANDRIDGE WAY, SUITE 230",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763467",
            "telephone_number": "703-858-5885",
            "fax_number": "703-858-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN MEDICAL GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOUDOUN MEDICAL GROUP, PC",
        "enumeration_date": "2007-03-19",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "TAMASY",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-737-6010"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced ENT Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.