NPIMap

Individual provider Active NPI

Cletus Asogo Atingatang, PA - C

  • Medical Physician Assistant
  • Adelphi, MD
National Provider Identifier
1679942635
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110008420 Issued in VA
Practice address
1812 Metzerott Rd Apt 46
Adelphi, MD 20783-5171
Phone
(301) 793-1802
NPI assigned
Sep 21, 2015
Last updated
Dec 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110008420 VA Primary

Addresses

Primary practice location

1812 Metzerott Rd Apt 46
Adelphi, MD 20783-5171

Mailing address

38 Cynthias PL Apt 302
Fredericksburg, VA 22406-7435
Phone (301) 793-1802

Other practice location 1

501 Sunset Ln
Culpeper, VA 22701-3917
Phone (540) 829-4100

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
I20220510000092 VA Practitioner - Physician Assistant 6305223538 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Urgent Care LLCGroup PAC ID 2062572456, 24 clinicians

Practice addresses (Care Compare)

12581 Milstead Way
Suite 103
Woodbridge, VA 22192-5425
Phone (703) 897-5890

15 S Gateway Dr
Suite 101
Fredericksburg, VA 22406-1231
Phone (540) 368-5603

330 White Oak Rd
Fredericksburg, VA 22405-2792
Phone (540) 373-2424

3990 Fettler Park Dr
Dumfries, VA 22025-1997
Phone (571) 499-5813

4105 Lewis and Clark Dr
Charlottesville, VA 22911-5833
Phone (434) 295-1000

501 Sunset LN
Culpeper, VA 22701-3917
Phone (703) 396-5293

5825 Plank Rd
Suite 105
Fredericksburg, VA 22407-5207
Phone (540) 785-2727

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110008420VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
NMG Affiliate Practice I, LLC CurrentSince Oct 28, 2024 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Oct 28, 2024 Accepting new patients
Short Pump Family Care, LLC PastSince Feb 1, 2016 Accepting new patients
Blue Ridge Healthcare Partners, LLC Past Accepting new patients

Locations

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

501 Sunset Ln
Culpeper, VA 22701
Phone (540) 829-4100

Interoperability endpoints

  • Direct secure messaging: catingatang91782@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 7

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 2

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": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1679942635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 CYNTHIAS PL APT 302",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224067435",
            "telephone_number": "301-793-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 METZEROTT RD APT 46",
            "city": "ADELPHI",
            "state": "MD",
            "postal_code": "207835171",
            "telephone_number": "301-793-1802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Sunset Ln",
            "address_purpose": "LOCATION",
            "city": "Culpeper",
            "state": "VA",
            "postal_code": "227013917",
            "country_code": "US",
            "telephone_number": "540-829-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ATINGATANG",
        "first_name": "CLETUS",
        "middle_name": "ASOGO",
        "credential": "PA - C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-21",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110008420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adelphi, MD

Sources for this page

Verify at the official NPI Registry.