NPIMap

Individual provider Active NPI

Manuel T Peralta Jr., M.D.

  • Family Medicine Physician
  • Forest, VA
National Provider Identifier
1245451194
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101241169 Issued in VA
Practice address
2103 Graves Mill Rd
Forest, VA 24551-2675
Phone
(434) 316-7199
Fax
(434) 316-6185
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101241169 VA Primary

Addresses

Primary practice location

2103 Graves Mill Rd
Forest, VA 24551-2675

Mailing address

2103 Graves Mill Rd
Forest, VA 24551-2675
Phone (434) 316-7199

Other identifiers 7

IdentifierTypeStateIssuer
1245451194OtherSOUTHERN HEALTH
1245451194MedicaidVA
014695A65OtherMEDICARE RAIL ROAD
1245451194OtherTRICARE
302185OtherANTHEM
3700863OtherCIGNA
541901162OtherPCHP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071004000120 VA Practitioner - Family Practice 9830284900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

1088 London Links Dr
Forest, VA 24551-4662
Phone (434) 534-6868

1175 Corporate Park Dr
Forest, VA 24551-2238
Phone (434) 525-6964

118 Oakwood Dr
Madison Heights, VA 24572-3001

131 Jones St
Appomattox, VA 24522-9830
Phone (434) 352-8235

2019 Tate Springs Rd
Lynchburg, VA 24501-1131
Phone (434) 846-7374

2215 Landover PL
Lynchburg, VA 24501-2115
Phone (434) 947-3944

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101241169VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Dec 15, 2016 Accepting new patients
Privia Medical Group, LLC Family Medicine CurrentSince Dec 15, 2016 Accepting new patients
Nova Physician Wellness Center PLLC Family Medicine Past Accepting new patients

Locations

2103 Graves Mill Rd
Forest, VA 24551
Phone (434) 316-7190

2019 Tate Springs Rd
Lynchburg, VA 24501
Phone (434) 845-7035

2019 Tate Springs Rd
Lowr
Lynchburg, VA 24501
Phone (434) 846-7708

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: manuel.peralta.1@8042.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1245451194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 GRAVES MILL RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245512675",
            "telephone_number": "434-316-7199",
            "fax_number": "434-316-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 GRAVES MILL RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245512675",
            "telephone_number": "434-316-7199",
            "fax_number": "434-316-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERALTA",
        "first_name": "MANUEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101241169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "1245451194",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245451194",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "014695A65",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1245451194",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "302185",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "3700863",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCHP",
            "identifier": "541901162",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

Verify at the official NPI Registry.