Family Medicine of Lake Ridge PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101040586 Issued in VA

Legal business name

FAMILY MEDICINE OF LAKE RIDGE PC

Practice address

3401 Commission CT
Ste 201
Woodbridge, VA 22192

Phone

(703) 490-6265

Fax

(703) 490-6713

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gerry A Cope, MD

Title

Physician

Phone

(703) 490-6265

Specialties & licenses 3

Addresses

Other names 1

• Family Medicine of Lake Ridge Other name

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donna Marie Goodin, CFNP

  • Family Nurse Practitioner
  • Woodbridge, VA
  • NPI 1972700862
  Medicare reassignment Care Compare group NPD
• Peter Allan Mendel, MD

  • Family Medicine Physician
  • Woodbridge, VA
  • NPI 1043219629
  Medicare reassignment Care Compare group NPD
• John James Wierzbicki, D.O.

  • Family Medicine Physician
  • Woodbridge, VA
  • NPI 1316932809
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417045816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 COMMISSION CT",
            "address_2": "STE 201",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-490-6265",
            "fax_number": "703-490-6713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 COMMISSION CT",
            "address_2": "STE 201",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-490-6265",
            "fax_number": "703-490-6713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF LAKE RIDGE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COPE",
        "authorized_official_first_name": "GERRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "703-490-6265",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101040586",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101039027",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0024057411",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine of Lake Ridge",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Faith Home Healthcare, LLC
• Tina Janet Falika King, M.D., M.P.H.
• Rachel Melissa Fama, PTA
• Family Chiropractic Center of Lake Ridge
• Family Medical Center Holding LLC
• Family Mental Health of Virginia, LLC
• Family Psychiatric Associates, P.C.
• Family Teamwork, Inc.
• Familyfirst Care LLC
• Familyorthopaedics and Sports Medicine of Northern Virginia P.C.

• Family Medicine Physician in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.