NPIMap

Organization Active NPI

Martha Jefferson Medical Group LLC

  • Family Medicine Physician
  • Charlottesville, VA
National Provider Identifier
1275720559
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARTHA JEFFERSON MEDICAL GROUP LLC
Practice address
590 Peter Jefferson Pkwy Ste 300
Charlottesville, VA 22911-4628
Phone
(434) 654-7340
Fax
(434) 654-7752
NPI assigned
Oct 1, 2007
Organization subpart
Yes
Parent organization
MARTHA JEFFERSON HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Dr. Bruce Clemons, MDNPI 1871536755
Title
Vice President, Medical Director
Phone
(434) 654-5229

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X VA Primary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X VA
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X VA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X VA
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X VA
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X VA
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X VA

Addresses

Primary practice location

590 Peter Jefferson Pkwy Ste 300
Charlottesville, VA 22911-4628

Mailing address

PO Box 746550
Atlanta, GA 30374-6550
Phone (434) 654-7340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080228000055 VA Part B Supplier - Clinic/Group Practice 5991889081 Receives reassigned benefits from 321 practitioners
Practice locations: Afton, VA; Zion Crossroads, VA; Waynesboro, VA; Ruckersville, VA; Palmyra, VA; Harrisonburg, VA; Crozet, VA; Charlottesville, VA

National Provider Directory

National Provider Directory
Part of
Martha Jefferson Med SV

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

500 Martha Jefferson Dr
#205B
Charlottesville, VA 22911

595 Martha Jefferson Dr
Ste 280
Charlottesville, VA 22911
Phone (434) 654-8920

500 Martha Jefferson Dr
Ste 415B
Charlottesville, VA 22911
Phone (434) 654-8960

500 Martha Jefferson Dr
Ste 205B
Charlottesville, VA 22911
Phone (434) 654-2845

500 Martha Jefferson Dr
#415B
Charlottesville, VA 22911
Phone (434) 654-8960

500 Martha Jefferson Dr
#G254
Charlottesville, VA 22911

595 Martha Jefferson Dr
Ste 180
Charlottesville, VA 22911
Phone (434) 654-5575

500 Martha Jefferson Dr
#505
Charlottesville, VA 22911

1149 Rose Hill Dr
Ste F
Charlottesville, VA 22903
Phone (434) 654-8700

500 Martha Jefferson Dr
#415A
Charlottesville, VA 22911
Phone (434) 654-8960

590 Peter Jefferson Pkwy
Ste 100A
Charlottesville, VA 22911
Phone (434) 654-8930

315 10th St NE
Ste B
Charlottesville, VA 22902

950 E High St
Ste 201
Charlottesville, VA 22902
Phone (434) 654-2870

595 Martha Jefferson Dr
#180
Charlottesville, VA 22911

310 Old Ivy Way
Ste 202
Charlottesville, VA 22903
Phone (434) 654-5575

2250 Ivy Rd
Ste 220
Charlottesville, VA 22903
Phone 4346543710 ext. 89372

315 Merchant Walk Sq
Ste 400
Charlottesville, VA 22902
Phone (434) 654-1800

595 Martha Jefferson Dr
Ste 320
Charlottesvle, VA 22911
Phone (434) 654-8715

1100 E High St
Ste 2B
Charlottesvle, VA 22902
Phone (434) 293-9294

600 Peter Jefferson Pkwy
Ste 270
Charlottesvle, VA 22911
Phone (434) 654-8920

675 Peter Jefferson Pkwy
Ste 140
Charlottesvle, VA 22911
Phone (434) 295-6374

1649 Park RDG Dr Ste a
Crozet, VA 22932

140 Stoneridge Dr S
Ste 100
Ruckersville, VA 22968
Phone (434) 654-1850

140 Stoneridge Dr S
Ruckersville, VA 22968
Phone (434) 654-1850

760 Town Center Dr
Ste 760
Waynesboro, VA 22980

Practitioners & affiliated clinicians

Practitioners 331

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 331

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1275720559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746550",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746550",
            "telephone_number": "434-654-7340",
            "fax_number": "434-654-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 PETER JEFFERSON PKWY STE 300",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229114628",
            "telephone_number": "434-654-7340",
            "fax_number": "434-654-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA JEFFERSON MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARTHA JEFFERSON HOSPITAL",
        "enumeration_date": "2007-10-01",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "CLEMONS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VICE PRESIDENT, MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "434-654-5229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "VA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.