NPIMap

Individual provider Active NPI

Roosevelt Dean Jr., DO

  • Family Medicine Physician
  • King George, VA
National Provider Identifier
1245486802
Registry record updated Mar 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102202137 Issued in VA
Practice address
11131 Journal Parkway
King George, VA 22485
Phone
(540) 625-2527
Fax
(540) 709-7211
NPI assigned
Aug 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2015

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 0102202137 VA Primary

Addresses

Primary practice location

11131 Journal Parkway
King George, VA 22485

Mailing address

11131 Journal Parkway
King George, VA 22485
Phone (540) 625-2527

Other identifiers 1

IdentifierTypeStateIssuer
1245486802MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090407000310 VA Practitioner - Family Practice 5799832804 Reassigns benefits to 1 organization
I20160921000039 DC Practitioner - Family Practice 5799832804 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLC 1,522 clinicians

Practice addresses (Care Compare)

13820 Smoketown Rd
Woodbridge, VA 22192-4210
Phone (703) 348-9111

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

9470 Annapolis Rd
Suite 309
Lanham, MD 20706-3022
Phone (202) 832-1800

9801 Patriot Hwy
Fredericksburg, VA 22407-9422
Phone (703) 348-9111

Hospital & facility affiliations

  • Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022
  • Spotsylvania Regional Medical Center Hospital, Fredericksburg, VA, CCN 490141

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Feb 1, 2025 Accepting new patients
Privia Medical Group, LLC Family Medicine CurrentSince Feb 1, 2025 Accepting new patients
Accessible Physician Home Care, LLC Past Accepting new patients
King George Medical Center LTD Family Medicine Past Accepting new patients
Nova Physician Wellness Center PLLC Family Medicine Past Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

7609 Richmond Hwy
#B
Alexandria, VA 22306
Phone (703) 347-9440

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

9801 Patriot Hwy
Fredericksburg, VA 22407

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: roosevelt.deen.1@8042.direct.athenahealth.com

Organizations & group practices 10

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 4

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": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425600000000",
    "number": "1245486802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11131 JOURNAL PARKWAY",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "22485",
            "telephone_number": "540-625-2527",
            "fax_number": "540-709-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11131 JOURNAL PARKWAY",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "22485",
            "telephone_number": "540-625-2527",
            "fax_number": "540-709-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "ROOSEVELT",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-14",
        "last_updated": "2015-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102202137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245486802",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in King George, VA

Sources for this page

Verify at the official NPI Registry.