Jessica Fantazos, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002900 Issued in VA

Practice address

14904 Jefferson Davis Hwy
Suite 103
Woodbridge, VA 22191-3908

Phone

(703) 497-4222

Fax

(703) 492-0164

NPI assigned

Jul 8, 2010

Last updated

Jul 8, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Merit-based Incentive Payment System (MIPS)

Final score

80.52 of 100Reported as group

Quality

56.13

Promoting interoperability

98

Improvement activities

40

Cost

80.61

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Gastroenterology Associates of Northern Virginia, LLC

  • Gastroenterology Physician
  • Fairfax, VA
  • NPI 1205884368

  DC

  Medicare reassignment
• Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
  • NPI 1902248677
  NPD (past)

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1558673350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14904 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 103",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913908",
            "telephone_number": "703-497-4222",
            "fax_number": "703-492-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14904 JEFFERSON DAVIS HWY",
            "address_2": "SUITE 103",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913908",
            "telephone_number": "703-497-4222",
            "fax_number": "703-492-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTAZOS",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Mental Health of Virginia, LLC (Ellie Mental Health)
• Family Psychiatric Associates, P.C. (Family Psychiatric Associates)
• Family Teamwork, Inc.
• Familyfirst Care LLC
• Familyorthopaedics and Sports Medicine of Northern Virginia P.C.
• Ramzia Faqier Pur
• Bassam Farah, MD
• Jon M Farber, MD
• Maidah Farooq, DDS
• Muazzam Farooq

• Medical Physician Assistant in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.

Verify at the official NPI Registry.