NPIMap

Organization Active NPI

Loudoun Community Health Center

Doing business as HealthWorks for Northern Virginia

  • Federally Qualified Health Center (FQHC)
  • Herndon, VA
National Provider Identifier
1629325758
Registry record updated Oct 29, 2014
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
1141 Elden Street
Third Floor
Herndon, VA 20170-5573
Phone
(703) 481-8160
Fax
(703) 435-6752
NPI assigned
Aug 8, 2012
Last updated
Oct 29, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

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

Authorized official

Name
Carol Jameson, MSW
Title
Executive Director
Phone
(703) 840-4704

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1141 Elden Street
Third Floor
Herndon, VA 20170-5573

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1629325758MedicaidVA

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
This NPI is an additional NPI on the enrollment
Practice locations: Sterling, VA; Leesburg, VA; Herndon, VA; Reston, VA
O20121022000521 VA Part A Provider - Federally Qualified Health Center (FQHC) 5193822930 Practice locations: Herndon, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629325758. Details of each certification follow.

Federally qualified health center certification: CCN 491919

Legal name
LOUDOUN COMMUNITY HEALTH CENTER
Doing business as
HERNDON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2012
Last certification
Oct 22, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 19, 2004 in VA
Enrollment address
1141 Elden Street
3Rd Floor
Herndon, VA 20170-5572

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.

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
49D1039731Healthworks for Northern Virginia - Herndon1141 Elden Street - Suite 300, Herndon, VA 20170Certificate of waiverApr 19, 2027

National Provider Directory

National Provider Directory

Locations

1141 Elden St
Fl Third
Herndon, VA 20170
Phone (703) 481-8160

Ownership & related parties

All disclosed owners & managing parties 14

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 Officer May 29, 2020
OtherCfo May 29, 2020
Lynn Rubin Individual Corporate Officer Feb 4, 2014
Harry Bailey Individual Corporate DirectorVice President Oct 7, 2014
Zaheer Ahmed Individual Corporate Director Feb 3, 2015
Tonya M Adkins Individual W-2 Managing Employee Jun 1, 2022
Tracy Ault Individual Corporate Officer Jan 6, 2015
Morton Nachlas Individual Corporate Officer Aug 7, 2012
Josiane Mbakop Ngouankeu Individual Corporate Director May 6, 2014
Jeffrey Clayton Individual Corporate DirectorPresident Oct 1, 2012
Suzanne Phan Individual Corporate Director Jan 6, 2015
Cesar Rodriguez Individual Corporate Director Feb 4, 2014
Salah Salih Individual Corporate Director Jan 6, 2015
Barbara Schaufeld Individual Corporate DirectorMember Oct 6, 2010
Thomas Coughlin Individual Corporate DirectorSecretary Dec 1, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1629325758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS RD 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": "1141 ELDEN STREET",
            "address_2": "THIRD FLOOR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201705573",
            "telephone_number": "703-481-8160",
            "fax_number": "703-435-6752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "JAMESON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "703-840-4704",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629325758",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthWorks for Northern Virginia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Herndon, VA

Sources for this page

Verify at the official NPI Registry.