NPIMap

Organization Active NPI

Crestwood Pediatric Associates PC

  • Pediatrics Physician
  • Manassas, VA
National Provider Identifier
1629034897
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CRESTWOOD PEDIATRIC ASSOCIATES PC
Practice address
10623 Crestwood Dr
Manassas, VA 20109-3433
Phone
(703) 361-7131
Fax
(703) 330-2065
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sandy Mullins
Title
Office Manager
Phone
(703) 361-7131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

10623 Crestwood Dr
Manassas, VA 20109-3433

Mailing address

10623 Crestwood Dr
Manassas, VA 20109-3433
Phone (703) 361-7131

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0222970Crestwood Pediatric Associates, PC10623 Crestwood Drive, Manassas, VA 20109Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

10623 Crestwood Dr
Manassas, VA 20109
Phone (703) 361-7131

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629034897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10623 CRESTWOOD DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093433",
            "telephone_number": "703-361-7131",
            "fax_number": "703-330-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10623 CRESTWOOD DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093433",
            "telephone_number": "703-361-7131",
            "fax_number": "703-330-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD PEDIATRIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MULLINS",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-361-7131"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.