Individual provider Active NPI

Romaldo Desouza, M.D.

  • Pulmonary Disease Physician
  • Gainesville, VA
National Provider Identifier
1710953294
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
0101128303 Issued in VA
Practice address
6344 Tred Avon Place
Gainesville, VA 20155
Phone
(703) 217-6255
NPI assigned
Feb 24, 2006
Last updated
May 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 0101128303 VA Primary

Addresses

Primary practice location

6344 Tred Avon Place
Gainesville, VA 20155

Mailing address

12032 Winding Creek CT
Clifton, VA 20124-2242

Other identifiers 6

IdentifierTypeStateIssuer
017717400MedicaidDC
0006OtherDCCAREFIRST BC OF NCA NUMBE
211234OtherVATRIGON BC NUMBER
559930001MedicaidMD
005824184MedicaidVA
53309413OtherMDCAREFIRST BC NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040407000881 DC Practitioner - Internal MedicinePractitioner - Geriatric Medicine 3870586548 Practice locations: Alexandria, VA
I20090714000427 VA Practitioner - Internal MedicinePractitioner - Pulmonary DiseasePractitioner - Geriatric Medicine 3870586548 Reassigns benefits to 1 organization
Practice locations: Manassas Park, VA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101128303VAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Romaldo Desouza, MD CurrentSince Dec 12, 2021 Accepting new patients
Inova Health Care Services CurrentSince Mar 1, 2020 Accepting new patients
Inova Health Care Services Current Accepting new patients

Locations

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1710953294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12032 WINDING CREEK CT",
            "city": "CLIFTON",
            "state": "VA",
            "postal_code": "201242242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6344 TRED AVON PLACE",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "703-217-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESOUZA",
        "first_name": "ROMALDO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "VA",
            "license": "0101128303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017717400",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC OF NCA NUMBE",
            "identifier": "0006",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIGON BC NUMBER",
            "identifier": "211234",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "559930001",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005824184",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC NUMBER",
            "identifier": "53309413",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, VA

Sources for this page

Verify at the official NPI Registry.