Individual provider Active NPI

Matthew A Fitzer, MD

  • Surgery Physician
  • Reston, VA
National Provider Identifier
1366489098
Registry record updated May 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101250534 Issued in VA
Practice address
1850A Town Center Pkwy
Suite 301
Reston, VA 20190-5851
Phone
(703) 709-9701
Fax
(703) 709-8084
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 3, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2005010623 MO
Surgery Physician 208600000X 0101250534 VA Primary

Addresses

Primary practice location

1850A Town Center Pkwy
Suite 301
Reston, VA 20190-5851

Mailing address

1850A Town Center Pkwy
Suite 301
Reston, VA 20190-5851
Phone (703) 709-9701

Other identifiers 1

IdentifierTypeStateIssuer
207411307MedicaidMO

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
I20120627000580 DC Practitioner - General Surgery 0143259986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Eastern Virginia Medical School, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

171 Elden St
Herndon, VA 20170-4875
Phone (703) 709-9771

Hospital & facility affiliations

  • Inova Fair Oaks Hospital Hospital, Fairfax, VA, CCN 490101

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Bariatric Surgery P.C. Surgery CurrentSince May 2, 2012 Accepting new patients
William a Graber MD PC Surgery PastSince Jan 11, 2013 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
William a Graber MD Surgery Past Accepting new patients

Locations

171 Elden St
Ste 3B
Herndon, VA 20170
Phone (703) 709-9771

1850A Town Center Pkwy
Ste 301
Reston, VA 20190
Phone (703) 709-9701

Organizations & group practices 4

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336003200000",
    "number": "1366489098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850A TOWN CENTER PKWY",
            "address_2": "SUITE 301",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905851",
            "telephone_number": "703-709-9701",
            "fax_number": "703-709-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850A TOWN CENTER PKWY",
            "address_2": "SUITE 301",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905851",
            "telephone_number": "703-709-9701",
            "fax_number": "703-709-8084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZER",
        "first_name": "MATTHEW",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2012-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2005010623",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101250534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207411307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.