Prince William Pediatrics and Adolescent Center

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

0101230761 Issued in VA

Legal business name

PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER

Practice address

12722 Directors Loop
Woodbridge, VA 22192-2462

Phone

(703) 492-1400

Fax

(703) 492-0220

NPI assigned

Apr 22, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Ali Jadidi, M.D.NPI 1013010180

Title

Director

Phone

(703) 492-1400

Specialties & licenses 1

Addresses

Other identifiers 2

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Ali Jadidi, MD

  • Emergency Medicine Physician
  • Woodbridge, VA
  • NPI 1013010180
  NPD (past) Authorized official
• Flor I Lopez, FNP

  • Family Nurse Practitioner
  • Woodbridge, VA
  • NPI 1407521123
  NPD (past)
• Caitlin Elise McKearney, PNP

  • Pediatric Nurse Practitioner
  • Woodbridge, VA
  • NPI 1982109641
  NPD (past)
• Constance Chedester, FNP-BC

  • Family Nurse Practitioner
  • Huntsville, AL
  • NPI 1306481692
  NPD (past)
• Manpreet Sidhu, M.D.

  • Pediatrics Physician
  • Germantown, MD
  • NPI 1154567352
  NPD (past)

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

{
    "created_epoch": "1303430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303430400000",
    "number": "1689965865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12722 DIRECTORS LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-492-1400",
            "fax_number": "703-492-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12722 DIRECTORS LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-492-1400",
            "fax_number": "703-492-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE WILLIAM PEDIATRICS AND ADOLESCENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-22",
        "last_updated": "2011-04-22",
        "status": "A",
        "authorized_official_last_name": "JADIDI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-492-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0101230761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154567352",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013010180",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prince William Area Agency on Aging
• Prince William Chiropractic Clinic Inc
• Prince William Health District Dental
• Prince William Neurology Center Inc
• Prince William Parkway Dental PC
• Prince William Plastic Surgery and Spa Services Company, LLC
• Prince William Speech and Hearing Center, Inc
• Claria Lynna Prior
• Priority Medical Transport LLC
• Privia Medical Group

• Primary Care Clinic/Center in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Primary Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; 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.