NPIMap

Individual provider Active NPI

Gavin Blair Gore

  • Diagnostic Radiology Physician
  • Leesburg, VA
National Provider Identifier
1316189608
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101258174 Issued in VA
Practice address
19500 Sandridge Way, Suite 420
Leesburg, VA 20176-3467
Phone
(571) 375-8601
Fax
(571) 223-6773
NPI assigned
Apr 1, 2009
Last updated
Nov 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2013-02510 NC
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 0101258174 VA Primary

Addresses

Primary practice location

19500 Sandridge Way, Suite 420
Leesburg, VA 20176-3467

Mailing address

224-D Cornwall Street, NW, Suite 403
Leesburg, VA 20176-2704
Phone (703) 737-6010

Other practice location 1

1 Medical Center Boulevard
Winston-Salem, NC 27103-2705
Phone (336) 716-6388

Other identifiers 1

IdentifierTypeStateIssuer
1316189608MedicaidVA

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
I20150727000381 VA Practitioner - Diagnostic Radiology 7911210596 Reassigns benefits to 5 organizations
I20170615000158 DC Practitioner - Diagnostic Radiology 7911210596 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MRI of Reston, LPGroup PAC ID 3476544701, 15 clinicians
Pet of Reston, LPGroup PAC ID 7214975978, 7 clinicians
Reston Radiology Consultants, PCGroup PAC ID 1557436730, 35 clinicians

Practice addresses (Care Compare)

1800 Town Ctr Dr
Suite 115
Reston, VA 20190-3237
Phone (703) 478-0922

1850 Town Ctr Pkwy
Reston, VA 20190-3204
Phone (703) 478-0922

24440 Stone Springs Blvd
Sterling, VA 20166-2247
Phone (703) 726-1201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.65 of 100Reported as apm
Quality
85.31
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
50 of 100Reported as group
Quality
0
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.54 of 100Reported as group
Quality
84.62
Improvement activities
40
Cost
76.68

Merit-based Incentive Payment System (MIPS)

Final score
68.81 of 100Reported as group
Quality
37.61
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75.84 of 100Reported as group
Quality
51.68
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
50 of 100Reported as group
Quality
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013-02510NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loudoun Imaging Center/Ashburn, LLC Diagnostic Radiology CurrentSince Jul 17, 2017 Accepting new patients
Loudoun Medical Group, PC CurrentSince Apr 1, 2021 Accepting new patients
Radiology Associates of Roanoke P C Diagnostic Radiology CurrentSince Jul 15, 2015 Accepting new patients
Pet of Reston, LP Diagnostic Radiology CurrentSince Jul 17, 2017 Accepting new patients
Loudoun Medical Group, PC CurrentSince Apr 1, 2021 Accepting new patients
Reston Radiology Consultants, PC Diagnostic Radiology CurrentSince Jul 17, 2017 Accepting new patients
MRI of Reston, LP Diagnostic Radiology CurrentSince Jul 15, 2017 Accepting new patients
Fair Oaks Imaging Center, PC Diagnostic Radiology CurrentSince Jul 17, 2017 Accepting new patients

Locations

20955 Professional Plz
Ste 200
Ashburn, VA 20147
Phone (703) 729-7652

20905 Professional Plz
Ste 100
Ashburn, VA 20147
Phone (571) 223-0230

21785 Filigree Ct
Ste 101
Ashburn, VA 20147
Phone (571) 919-2897

4001 Fair Ridge Dr
Ste 103
Fairfax, VA 22033
Phone (703) 385-5203

19500 Sandridge Way
Ste 460
Leesburg, VA 20176
Phone (571) 206-0767

224D Cornwall St NW
Ste 403
Leesburg, VA 20176
Phone (703) 737-6001

19500 Sandridge Way
Ste 420
Leesburg, VA 20176
Phone (571) 375-8601

44055 Riverside Pkwy
Ste 208
Leesburg, VA 20176
Phone (703) 729-7652

1850 Town Center Pkwy
Reston, VA 20190
Phone (703) 478-0922

1830 Town Center Dr
Ste 105
Reston, VA 20190
Phone (571) 601-2901

1800 Town Center Dr
Ste 115
Reston, VA 20190
Phone (703) 478-0922

4330 Brambleton Ave
Roanoke, VA 24018
Phone (540) 283-3700

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

24440 Stone Springs Blvd
Sterling, VA 20166
Phone (571) 206-8696

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1238544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1316189608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL STREET, NW, SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19500 SANDRIDGE WAY, SUITE 420",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763467",
            "telephone_number": "571-375-8601",
            "fax_number": "571-223-6773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Boulevard",
            "address_purpose": "LOCATION",
            "city": "Winston-Salem",
            "state": "NC",
            "postal_code": "271032705",
            "country_code": "US",
            "telephone_number": "336-716-6388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORE",
        "first_name": "GAVIN",
        "middle_name": "BLAIR",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-01",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2013-02510",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101258174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316189608",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.