NPIMap

Organization Active NPI

Loudoun Community Health Center

Doing business as HealthWorks for Northern Virginia

  • Federally Qualified Health Center (FQHC)
  • Leesburg, VA
National Provider Identifier
1629109806
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOUDOUN COMMUNITY HEALTH CENTER
Doing business as
HealthWorks for Northern Virginia
Practice address
163 Fort Evans Road NE
Leesburg, VA 20176-4420
Phone
(703) 443-2000
Fax
(703) 443-2033
NPI assigned
Mar 8, 2007
Last updated
Sep 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Amandeep Dhindsa, CFO
Title
Chief Financial Officer
Phone
(703) 840-4707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X VA Primary
Mammography Clinic/Center 261QR0206X

Addresses

Primary practice location

163 Fort Evans Road NE
Leesburg, VA 20176-4420

Mailing address

163 Fort Evans Road, NE
Leesburg, VA 20176-4420
Phone (703) 840-4707

Other identifiers 1

IdentifierTypeStateIssuer
1629109806MedicaidVA

Other names 1

  • HealthWorks for Northern Virginia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070514000106 VA Part B Supplier - Clinic/Group Practice 5193822930 Receives reassigned benefits from 23 practitioners
3 other NPIs on this enrollment
Practice locations: Sterling, VA; Leesburg, VA; Herndon, VA; Reston, VA
O20080801000148 VA Part A Provider - Federally Qualified Health Center (FQHC) 5193822930 Practice locations: Leesburg, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629109806. Details of each certification follow.

Federally qualified health center certification: CCN 491887

Legal name
LOUDOUN COMMUNITY HEALTH CENTER
Doing business as
HEALTHWORKS FOR NORTHERN VIRGINIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2008
Last certification
Oct 17, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 19, 2004 in VA
Enrollment address
163 Fort Evans Rd. NE
Leesburg, VA 20176-4420

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

13800 Wall Rd
Ste 55
Herndon, VA 20171

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Amandeep Dhindsa Individual Corporate OfficerChief Financial Officer May 1, 2020
W-2 Managing EmployeeChief Financial Officer May 1, 2020
Lynn Rubin Individual Corporate DirectorMember Oct 7, 2009
Harry Bailey Individual Corporate DirectorVice President Oct 7, 2014
Zaheer Ahmed Individual Corporate Officer Feb 3, 2015
Tracy Ault Individual Corporate Officer Jan 6, 2015
Morton Nachlas Individual Corporate Officer Aug 7, 2012
Cardinal Bank Organization, McLean, VA Financial institution 5% Or Greater Mortgage Interest Aug 5, 2014 29%
Josiane Mbakop Ngouankeu Individual Corporate Officer May 6, 2014
Jeffrey Clayton Individual Corporate DirectorPresident Oct 1, 2012
Robine Hardey Individual Corporate OfficerCfo Oct 23, 2014
W-2 Managing Employee Oct 23, 2014
Suzanne Phan Individual Corporate Officer Jan 6, 2015
Cesar Rodriguez Individual Corporate Officer Feb 4, 2014
Salah Salih Individual Corporate Officer Jan 6, 2015
Carol Jameson Individual Corporate OfficerCeo Feb 19, 2014
W-2 Managing Employee Feb 19, 2014
Barbara Schaufeld Individual Corporate DirectorMember Oct 6, 2010
Stephan-Paul Gifford Individual Corporate DirectorMember Apr 8, 2009
Thomas Coughlin Individual Corporate DirectorSecretary Dec 1, 2010

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1629109806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS ROAD, NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764420",
            "telephone_number": "703-840-4707",
            "fax_number": "703-771-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS ROAD NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764420",
            "telephone_number": "703-443-2000",
            "fax_number": "703-443-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "DHINDSA",
        "authorized_official_first_name": "AMANDEEP",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "703-840-4707",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629109806",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthWorks for Northern Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.