NPIMap

Organization Active NPI

Uva Community Health Medical Group, LLC

Doing business as UVA Health Behavioral Health Manassas

  • Psychiatry Physician
  • Manassas, VA
National Provider Identifier
1386053502
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
UVA COMMUNITY HEALTH MEDICAL GROUP, LLC
Doing business as
UVA Health Behavioral Health Manassas
Practice address
8644 Sudley Rd
Suite 315
Manassas, VA 20110-4417
Phone
(703) 369-8055
Fax
(703) 369-8565
NPI assigned
Aug 13, 2014
Last updated
Sep 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Charles D. Coder
Title
Cfo
Phone
(804) 835-2069

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Clinical Social Worker 1041C0700X NU
Psychiatry Physician 2084P0800X NU Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU

Addresses

Primary practice location

8644 Sudley Rd
Suite 315
Manassas, VA 20110-4417

Mailing address

PO Box 748613
Atlanta, GA 30384-8613

Other names 1

  • UVA Health Behavioral Health Manassas Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110311000151 VA Part B Supplier - Clinic/Group Practice 4688587967 Receives reassigned benefits from 608 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Manassas, VA; Haymarket, VA; Keswick, VA; Prince William, VA; Richmond, VA; South Riding, VA; Warrenton, VA; Winchester, VA…

National Provider Directory

National Provider Directory
Tax ID family
Uva Community Health Medical Group LLC42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1386053502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8644 SUDLEY RD",
            "address_2": "SUITE 315",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104417",
            "telephone_number": "703-369-8055",
            "fax_number": "703-369-8565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UVA COMMUNITY HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "CODER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "804-835-2069"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UVA Health Behavioral Health Manassas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.