Individual provider Active NPI

Bruce M Freedman, MD

  • Plastic and Reconstructive Surgery Physician
  • Reston, VA
National Provider Identifier
1316922503
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
0101043977 Issued in VA
Practice address
1800 Town Center Dr
Ste 413
Reston, VA 20190-3240
Phone
(703) 790-5700
Fax
(703) 827-8730
NPI assigned
Dec 9, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 0101043977 VA Primary

Addresses

Primary practice location

1800 Town Center Dr
Ste 413
Reston, VA 20190-3240

Mailing address

1800 Town Center Dr
Ste 413
Reston, VA 20190-3240
Phone (703) 790-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130123000146 DC Practitioner - Plastic and Reconstructive Surgery 8022261130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Duke University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1860 Town Ctr Dr
Suite 180
Reston, VA 20190-5905
Phone (571) 525-2316

Hospital & facility affiliations

  • Reston Hospital Center Hospital, Reston, VA, CCN 490107

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101043977VAMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crowell Reconstructive Surgery PLLC CurrentSince Mar 13, 2020 Accepting new patients

Locations

1800 Town Center Dr
Ste 413
Reston, VA 20190
Phone (443) 646-5000

1860 Town Center Dr
Ste 180
Reston, VA 20190
Phone (571) 525-2316

Organizations & group practices 1

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 1

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": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1316922503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 TOWN CENTER DR",
            "address_2": "STE 413",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903240",
            "telephone_number": "703-790-5700",
            "fax_number": "703-827-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 TOWN CENTER DR",
            "address_2": "STE 413",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903240",
            "telephone_number": "703-790-5700",
            "fax_number": "703-827-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEDMAN",
        "first_name": "BRUCE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-09",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "VA",
            "license": "0101043977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.