NPIMap

Individual provider Active NPI

Ken Lee Moles, MD

  • Family Medicine Physician
  • Burke, VA
National Provider Identifier
1396716379
Registry record updated Jun 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101048454 Issued in VA
Practice address
9409 B Old Burke Lake Rd
Burke, VA 22015
Phone
(703) 978-4200
Fax
(703) 503-8263
NPI assigned
Jan 30, 2006
Last updated
Jun 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101048454 VA Primary

Addresses

Primary practice location

9409 B Old Burke Lake Rd
Burke, VA 22015

Mailing address

9409 B Old Burke Lake Rd
Burke, VA 22015
Phone (703) 978-4200

Other identifiers 1

IdentifierTypeStateIssuer
5638216MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 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
I20110228000889 DC Practitioner - Family Practice 7416138144 Reassigns benefits to 1 organization
I20150715000143 VA Practitioner - Family Practice 7416138144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Virginia School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

9409 B Old Burke Lake Rd
Burke, VA 22015-3127
Phone (703) 978-4200

9470 Annapolis Rd
Suite 309
Lanham, MD 20706-3022
Phone (202) 832-1800

950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173

9642 Burke Lake Rd
Burke, VA 22015-3052
Phone (703) 543-7920

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Family Medicine CurrentSince May 3, 2015 Accepting new patients
Privia Medical Group, LLC CurrentSince May 3, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Medical Associates of Central Virginia, Inc. Past Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

9409B Old Burke Lake Rd
Burke, VA 22015
Phone (703) 978-4200

8644 Sudley Rd
#220
Manassas, VA 20110

Interoperability endpoints

  • Direct secure messaging: ken.moles.1@8042.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275955200000",
    "number": "1396716379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9409 B OLD BURKE LAKE RD",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "22015",
            "telephone_number": "703-978-4200",
            "fax_number": "703-503-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9409 B OLD BURKE LAKE RD",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "22015",
            "telephone_number": "703-978-4200",
            "fax_number": "703-503-8263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLES",
        "first_name": "KEN",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2010-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101048454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5638216",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burke, VA

Sources for this page

Verify at the official NPI Registry.