NPIMap

Individual provider Active NPI

Michael D Perez, M.D.

  • Family Medicine Physician
  • Manassas, VA
National Provider Identifier
1609876135
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101043080 Issued in VA
Practice address
8640 Sudley Rd
Suite 203
Manassas, VA 20110-4420
Phone
(703) 368-3161
Fax
(703) 368-2498
NPI assigned
Jul 27, 2005
Last updated
Feb 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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 0101043080 VA Primary

Addresses

Primary practice location

8640 Sudley Rd
Suite 203
Manassas, VA 20110-4420

Mailing address

PO Box 748613
Atlanta, GA 30384-8613

Other identifiers 2

IdentifierTypeStateIssuer
1609876135MedicaidVA
5617235MedicaidVA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mperez29961@direct.novanthealth.org

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
I20100604000302 VA Practitioner - Family Practice 3779482088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Ohio, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10322 Bristow Ctr Dr
Bristow, VA 20136-2201
Phone (571) 261-3270

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Uva Community Health Medical Group, LLC CurrentSince Jan 1, 2011 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Jan 1, 2011 Accepting new patients
NMG Affiliate Practice I, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

10322 Bristow Center Dr
Bristow, VA 20136
Phone (571) 284-4230

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

8640 Sudley Rd
Ste 203
Manassas, VA 20110
Phone (703) 368-3161

Interoperability endpoints

  • Direct secure messaging: mperez29961@direct.novanthealth.org
  • Direct secure messaging: mperez517025@direct.healthsystem.virginia.edu

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 4

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": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1609876135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8640 SUDLEY RD",
            "address_2": "SUITE 203",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104420",
            "telephone_number": "703-368-3161",
            "fax_number": "703-368-2498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-27",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101043080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609876135",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5617235",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mperez29961@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "8640 Sudley Rd",
            "address_2": "Suite 203",
            "city": "Manassas",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201104420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

Verify at the official NPI Registry.