Mingliarti Tjahjana, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101236144 Issued in VA

Practice address

1850 Town Center Pkwy
Suite 410
Reston, VA 20190-3219

Phone

(571) 572-9198

Fax

(571) 482-6080

NPI assigned

Aug 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 31, 2016 through Mar 31, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DHCHAD/Endpoint/DHCHAD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• One Health Medical Care, LLC

  • Internal Medicine Physician
  • Reston, VA
  • NPI 1598291791
  NPD (past) Authorized official

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1649280215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12504 ALEXANDER CORNELL DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332437",
            "telephone_number": "571-338-9054",
            "fax_number": "571-482-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 TOWN CENTER PKWY",
            "address_2": "SUITE 410",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201903219",
            "telephone_number": "571-572-9198",
            "fax_number": "571-482-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TJAHJANA",
        "first_name": "MINGLIARTI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101236144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa G Tibbetts, DPT
• Emma Maria Tierney
• Susan Hanley Tilton, MD
• Stephane Tisseront, DDS, MS
• Charles Cameron Titus, MD
• TLC the Laser Center (Northeast) Inc.
• Jamieson Tobey, LPTA
• Lindsay R Tom, PA
• Quang That Ton, PT, DPT
• James L Torrens, MD

• Internal Medicine Physician in Reston, VA
• Providers in Reston, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.