Individual provider Active NPI

Justin Beverage

  • Clinical Social Worker
  • Alexandria, VA
National Provider Identifier
1497505358
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904016571 Issued in VA
Practice address
6901 S Van Dorn St
Alexandria, VA 22315-3961
Phone
(703) 313-6314
NPI assigned
Mar 25, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904016571 VA Primary

Addresses

Primary practice location

6901 S Van Dorn St
Alexandria, VA 22315-3961

Mailing address

6901 S Van Dorn St
Alexandria, VA 22315-3961
Phone (703) 313-6314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240404003073 DC Practitioner - Clinical Social Worker 4688012925 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904016571VAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia CurrentSince Mar 3, 2024 Accepting new patients

Locations

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-7017

6901 S Van Dorn St
Kingstowne, VA 22315
Phone (703) 313-6300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1497505358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 S VAN DORN ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223153961",
            "telephone_number": "703-313-6314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 S VAN DORN ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223153961",
            "telephone_number": "703-313-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVERAGE",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.