NPIMap

Loudoun Medical Group, PC

Organization Active NPI Family Medicine Physician · Sterling, VA

NPI 1508990110 · NPPES record last updated Apr 24, 2023

Key facts

NPI
1508990110
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Practice address
46440 Benedict Drive, Suite 107
Sterling, VA 20164-6602
Phone
(703) 450-1125
Fax
(703) 450-1145
NPI assigned
Mar 15, 2007
Organization subpart
Yes
Parent organization (as reported)
LOUDOUN MEDICAL GROUP, PC

Authorized official

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

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.

Other NPIs on the same Medicare enrollment 25

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2233303LMG Primary Care Center
46440 Benedict Dr Suite 107, Sterling, VA 20164		Provider-performed microscopyAug 22, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041115000474 VA Part B Supplier - Clinic/Group Practice 0042119661 Receives reassigned benefits from 340 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Walter M Obrien MD (305 organizations share this tax ID)
Part of
Walter M Obrien MD

Locations

205 Hirst Rd
Ste 304
Purcellville, VA 20132
Phone (703) 723-3398

46440 Benedict Dr
Ste 107B
Sterling, VA 20164

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

46440 Benedict Drive, Suite 107
Sterling, VA 20164-6602

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
CG8678OtherVARR MEDICARE PIN

Other names

  • LMG Primary Care Center Doing business as

Other providers in Sterling, VA

All providers in Sterling, VA · Family Medicine Physician in Virginia

Sources for this page

Verify at the official NPI Registry.