Individual provider Active NPI

Logan Griffiths, PA-C

  • Physician Assistant
  • Reston, VA
National Provider Identifier
1588150437
Registry record updated Jul 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110006257 Issued in VA
Practice address
1850 Town Center Pkwy Ste 400
Reston, VA 20190-3219
Phone
(703) 810-5202
Fax
(703) 810-5420
NPI assigned
Jul 3, 2018
Last updated
Jul 3, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110006257 VA Primary

Addresses

Primary practice location

1850 Town Center Pkwy Ste 400
Reston, VA 20190-3219

Mailing address

PO Box 75868
Baltimore, MD 21275-5868

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210427002447 TN Practitioner - Physician Assistant 4183973084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Albany Medical College of Union University, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

111 W Stone Dr
Kingsport, TN 37660-6027

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

410 N State of Franklin Rd
Suite 140
Johnson City, TN 37604-6972
Phone (423) 431-2460

410 N State of Franklin Rd
Suite 140B
Johnson City, TN 37604-6971
Phone (423) 431-2460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince May 23, 2021 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince May 23, 2021 Accepting new patients
Blue Ridge Medical Management Corporation Physician Assistant Past Accepting new patients

Locations

410 N State of Franklin Rd
Ste 140
Johnson City, TN 37604
Phone (423) 431-2460

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

Organizations & group practices 4

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 3

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": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530576000000",
    "number": "1588150437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 75868",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212755868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 TOWN CENTER PKWY STE 400",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903219",
            "telephone_number": "703-810-5202",
            "fax_number": "703-810-5420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIFFITHS",
        "first_name": "LOGAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-03",
        "last_updated": "2018-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.