NPIMap

Individual provider Active NPI

Kelly M Rodriguez, MD

  • Family Medicine Physician
  • Ashburn, VA
National Provider Identifier
1568455103
Registry record updated Oct 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101231491 Issued in VA
Practice address
20905 Professional PLZ
Ste 330
Ashburn, VA 20147-7783
Phone
(703) 726-0003
Fax
(703) 726-6444
NPI assigned
Aug 30, 2005
Last updated
Oct 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101231491 VA Primary

Addresses

Primary practice location

20905 Professional PLZ
Ste 330
Ashburn, VA 20147-7783

Mailing address

950N Glebe Rd 4000
Arlington, VA 22203-1824
Phone (571) 295-7514

Other identifiers 2

IdentifierTypeStateIssuer
05647096MedicaidVA
P00010206OtherRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krodriguez27854@soc.inova.org Health Information Exchange (HIE) Inova Physician Partners, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040504000622 VA Practitioner - Family Practice 7719975234 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairfax Family Practice Centers PCGroup PAC ID 4082513031, 106 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

20905 Professional PLZ
Suite 330
Ashburn, VA 20147-3409
Phone (703) 726-0003

9642 Burke Lake Rd
Burke, VA 22015-3052
Phone (703) 543-7920

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Family Medicine CurrentSince Jun 24, 2015 Accepting new patients
Inova Physician Partners, LLC Family Medicine CurrentSince Jun 25, 2020 Accepting new patients
Privia Medical Group, LLC CurrentSince Jun 24, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Bestpractices, Inc. Past Accepting new patients
Privia Pediatric Medical Group of Georgia LLC Past Accepting new patients
Bestpractices, Inc. Past Accepting new patients
Inova Physician Partners, Inc. - Specialists Past Accepting new patients

Locations

20905 Professional Plz
Ste 330
Ashburn, VA 20147
Phone (703) 726-0003

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

8644 Sudley Rd
#220
Manassas, VA 20110

740 E Main St
Purcellville, VA 20132
Phone (540) 338-4995

Interoperability endpoints

  • Direct secure messaging: krodriguez27854@soc.inova.org

Organizations & group practices 9

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602979200000",
    "number": "1568455103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950N GLEBE RD 4000",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031824",
            "telephone_number": "571-295-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20905 PROFESSIONAL PLZ",
            "address_2": "STE 330",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201477783",
            "telephone_number": "703-726-0003",
            "fax_number": "703-726-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101231491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05647096",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00010206",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krodriguez27854@soc.inova.org",
            "affiliation": "Y",
            "endpointDescription": "Health Information Exchange",
            "affiliationName": "Inova Physician Partners, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "20905 Professional Plz",
            "address_2": "Ste 330",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201477783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ashburn, VA

Sources for this page

Verify at the official NPI Registry.