Individual provider Active NPI

Robert G Rother, LCSW

  • Clinical Social Worker
  • Reston, VA
National Provider Identifier
1215955836
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904004526 Issued in VA
Practice address
11260 Roger Bacon Dr
# 500
Reston, VA 20190-5227
Phone
(571) 437-5455
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904004526 VA Primary

Addresses

Primary practice location

11260 Roger Bacon Dr
# 500
Reston, VA 20190-5227

Mailing address

1465 Hunter View Farms
Vienna, VA 22182-1552
Phone (571) 437-5455

Other identifiers 2

IdentifierTypeStateIssuer
0007466396OtherVAAETNA
0904004526OtherVALCSW DEPT OF HEALTH PROFF

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0904004526VAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215955836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 HUNTER VIEW FARMS",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221821552",
            "telephone_number": "571-437-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11260 ROGER BACON DR",
            "address_2": "# 500",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905227",
            "telephone_number": "571-437-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHER",
        "first_name": "ROBERT",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904004526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007466396",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW DEPT OF HEALTH PROFF",
            "identifier": "0904004526",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.