Active NPI
Mary C Tisch, PA
- Physician Assistant
- Fairfax, VA
National Provider Identifier
1558566455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110003594
- Practice address
- 3580 Joseph Siewick Dr Ste 305
Fairfax, VA 22033-1764 - Phone
- (703) 648-3266
- Fax
- (703) 648-3264
- NPI assigned
- Jun 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110003594 | VA | Primary |
Addresses
Primary practice location
3580 Joseph Siewick Dr Ste 305
Fairfax, VA 22033-1764
Mailing address
2901 Telestar CT.
#300
Falls Church, VA 22042-1263
Phone (703) 591-1688
Other practice location 1
2901 Telestar Ct.
#200
Falls Church, VA 22042-1262
Phone (703) 573-3494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558566445 | Medicaid | VA |
Other names 1
- Mary C Campbell
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mtisch26336@soc.inova.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2901 Telestar CT
Suite 300
Falls Church, VA 22042-1261
8110 Gatehouse Rd
Suite 300W
Falls Church, VA 22042-1217
Hospital & facility affiliations
- Inova Fairfax Hospital
- Inova Fair Oaks Hospital
- Inova Alexandria Hospital
- Inova Loudoun Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.36 of 100
- Quality
- 73.03
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 71.49
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfax Radiological Consultants | Past | Accepting new patients |
Interoperability endpoints
- mtisch26336@soc.inova.org
Organizations & group practices 2
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.
-
- Specialist
- Falls Church, VA
- NPI 1114902509
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Alexandria, VA
- NPI 1255684460
-
- Psychiatric Hospital Unit
- Leesburg, VA
- NPI 1285786228
-
- General Acute Care Hospital
- Leesburg, VA
- NPI 1376564302
-
- Rehabilitation Hospital Unit
- Falls Church, VA
- NPI 1588795462
-
- General Acute Care Hospital
- Fairfax, VA
- NPI 1760513980
-
- General Acute Care Hospital
- Falls Church, VA
- NPI 1831220714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630022400000",
"number": "1558566455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 TELESTAR CT.",
"address_2": "#300",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220421263",
"telephone_number": "703-591-1688",
"fax_number": "703-591-1445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3580 JOSEPH SIEWICK DR STE 305",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331764",
"telephone_number": "703-648-3266",
"fax_number": "703-648-3264"
}
],
"practiceLocations": [
{
"address_1": "2901 Telestar Ct.",
"address_2": "#200",
"address_purpose": "LOCATION",
"city": "Falls Church",
"state": "VA",
"postal_code": "220421262",
"country_code": "US",
"telephone_number": "703-573-3494",
"fax_number": "703-573-5353",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TISCH",
"first_name": "MARY",
"middle_name": "C",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-19",
"last_updated": "2021-08-27",
"certification_date": "2021-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110003594",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1558566445",
"state": "VA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mtisch26336@soc.inova.org",
"affiliation": "N",
"address_1": "3580 Joseph Siewick Dr Ste 305",
"city": "Fairfax",
"state": "VA",
"country_code": "US",
"postal_code": "220331764",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "MARY",
"last_name": "CAMPBELL",
"middle_name": "C",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.