Individual provider Active NPI

Ian H Leibowitz, M.D.

  • Pediatric Gastroenterology Physician
  • Washington, DC
National Provider Identifier
1225004815
Registry record updated Feb 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
MDO46686 Issued in DC
Practice address
111 Michigan Ave NW
Washington, DC 20010
Phone
(202) 476-5000
NPI assigned
Feb 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 0101036573 VA
Pediatric Gastroenterology Physician 2080P0206X MDO46686 DC Primary

Addresses

Primary practice location

111 Michigan Ave NW
Washington, DC 20010

Mailing address

PO Box 744785
Atlanta, GA 30374-4785
Phone (202) 476-5000

Other practice location 1

3022 Williams Dr
Suite 301
Fairfax, VA 22031-4600
Phone (703) 698-8960 ext. 238

Other practice location 2

3023 Hamaker Ct Fl 6
Fairfax, VA 22031-2207
Phone (703) 876-2788

Other identifiers 1

IdentifierTypeStateIssuer
6071787MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070301000206 DC Practitioner - GastroenterologyPractitioner - Internal MedicinePractitioner - Pediatric Medicine 1759307093 Reassigns benefits to 1 organization
I20111214001062 VA Practitioner - GastroenterologyPractitioner - Pediatric Medicine 1759307093 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDO46686DCMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Current Accepting new patients
Children'S Hospital CurrentSince Feb 20, 2019 Accepting new patients
Children'S Hospital CurrentSince Feb 20, 2019 Accepting new patients
Old Dominion Anesthesia LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Gastroenterology Associates of Northern Virginia, LLC Pediatric Gastroenterology Past Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

3023 Hamaker Ct
Ste 400
Fairfax, VA 22031
Phone (571) 226-8380

3022 Williams Dr
Ste 301
Fairfax, VA 22031
Phone (703) 698-1775

3023 Hamaker Ct
Fl 6
Fairfax, VA 22031

Interoperability endpoints

  • Direct secure messaging: ileibowitz5593@soc.inova.org

Organizations & group practices 8

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1225004815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744785",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744785",
            "telephone_number": "202-476-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20010",
            "telephone_number": "202-476-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3022 Williams Dr",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314600",
            "country_code": "US",
            "telephone_number": "703-698-8960 x238",
            "fax_number": "703-641-8427",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3023 Hamaker Ct Fl 6",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220312207",
            "country_code": "US",
            "telephone_number": "703-876-2788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEIBOWITZ",
        "first_name": "IAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "VA",
            "license": "0101036573",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "DC",
            "license": "MDO46686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6071787",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.