NPIMap

Organization Active NPI

Loudoun Medical Group, PC

Doing business as Urogynecology Center of Northern Virginia

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Reston, VA
National Provider Identifier
1407908817
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Doing business as
Urogynecology Center of Northern Virginia
Practice address
1860 Town Center Drive, Suite 225
Reston, VA 20190-5905
Phone
(703) 293-5239
Fax
(571) 526-4393
NPI assigned
Jan 17, 2007
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LOUDOUN MEDICAL GROUP, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
Mary Beth Tamasy
Title
Ceo
Phone
(703) 737-6010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X Primary

Addresses

Primary practice location

1860 Town Center Drive, Suite 225
Reston, VA 20190-5905

Mailing address

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

Other names 1

  • Urogynecology Center of Northern Virginia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000616 DC Part B Supplier - Clinic/Group Practice 0042119661 Receives reassigned benefits from 154 practitioners
5 other NPIs on this enrollment
Practice locations: Reston, VA; Herndon, VA; Lorton, VA; MC Lean, VA; N Bethesda, MD; Springfield, VA; Vienna, VA; Fairfax, VA…

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
John M Archer MD

Locations

4660 Kenmore Ave
Ste 900
Alexandria, VA 22304
Phone (703) 212-0700

12005 Sunrise Valley Dr
Ste 120
Reston, VA 20191
Phone (571) 375-7174

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 166

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.

View all 166

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1407908817",
    "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": "1860 TOWN CENTER DRIVE, SUITE 225",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905905",
            "telephone_number": "703-293-5239",
            "fax_number": "571-526-4393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN MEDICAL GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOUDOUN MEDICAL GROUP, PC",
        "enumeration_date": "2007-01-17",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "TAMASY",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-737-6010"
    },
    "taxonomies": [
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urogynecology Center of Northern Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.