Centreville Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTREVILLE FAMILY PRACTICE

Practice address

13890 Braddock Rd
Suite 201
Centreville, VA 20121-2435

Phone

(703) 631-0331

Fax

(703) 631-2573

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Richard Boxley Bowles, M.D.

Title

President

Phone

(703) 631-0331

Specialties & licenses 1

Addresses

Other identifiers 12

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467532218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD",
            "address_2": "SUITE 201",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212435",
            "telephone_number": "703-631-0331",
            "fax_number": "703-631-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD",
            "address_2": "SUITE 201",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212435",
            "telephone_number": "703-631-0331",
            "fax_number": "703-631-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTREVILLE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOWLES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BOXLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-631-0331",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST KEYES",
            "identifier": "84280003",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BOWLES",
            "identifier": "015385",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM KEYES",
            "identifier": "054086",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BOWLES",
            "identifier": "7118167002",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP KEYES",
            "identifier": "299284",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA KEYES",
            "identifier": "7526767001",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BOWLES",
            "identifier": "84280002",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BOWLES",
            "identifier": "898399",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "0100537",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5674719",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP BOWLES",
            "identifier": "299304",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA KEYES",
            "identifier": "898405",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Centreville, VA
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• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.