Individual provider Active NPI

Ian Thomas Greenwalt, M.D.

  • Surgery Physician
  • Haymarket, VA
National Provider Identifier
1720405665
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101283801 Issued in VA
Practice address
15195 Heathcote Blvd Ste 240
Haymarket, VA 20169-6245
Phone
(571) 284-3460
NPI assigned
Mar 27, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Oncology Physician 2086X0206X MD047318 DC
Surgery Physician 208600000X 0101283801 VA Primary

Addresses

Primary practice location

15195 Heathcote Blvd Ste 240
Haymarket, VA 20169-6245

Mailing address

PO Box 748613
Atlanta, GA 30384-8613
Phone (434) 295-1000

Other practice location 1

3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone (202) 295-0560

Other practice location 2

15225 Heathcote Blvd
Haymarket, VA 20169-6264
Phone (571) 284-1000

Other practice location 3

8700 Sudley Rd
Manassas, VA 20110-4418
Phone (703) 369-8000

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
I20200812001674 DC Practitioner - Surgical Oncology 5193141810 Reassigns benefits to 1 organization
I20241015001399 VA Practitioner - General Surgery 5193141810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Drexel University College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uva Community Health Medical Group LLCGroup PAC ID 4688587967, 339 clinicians

Practice addresses (Care Compare)

15195 Heathcote Blvd
Suite 240
Haymarket, VA 20169-6245
Phone (571) 284-3460

Hospital & facility affiliations

  • Uva Health Haymarket Medical Center Hospital, Haymarket, VA, CCN 490144
  • Uva Health Prince William Medical Center Hospital, Manassas, VA, CCN 490045
  • Medstar Georgetown University Hospital Hospital, Washington, DC, CCN 090004
  • Fauquier Hospital Hospital, Warrenton, VA, CCN 490023

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy27
Melanoma (skin cancer) excision14
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD047318DCMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Sep 1, 2020 Accepting new patients
Medstar Medical Group II LLC CurrentSince Sep 1, 2020 Accepting new patients
Uva Community Health Medical Group, LLC CurrentSince Oct 1, 2024 Accepting new patients
Uva Community Health Medical Group, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

4105 Lewis and Clark Dr
Charlottesvle, VA 22911

15225 Heathcote Blvd
Haymarket, VA 20169
Phone (571) 284-1000

15195 Heathcote Blvd
Ste 240
Haymarket, VA 20169
Phone (571) 261-2782

8700 Sudley Rd
Manassas, VA 20110
Phone (703) 369-8000

Interoperability endpoints

  • Direct secure messaging: igreenwalt647889@direct.healthsystem.virginia.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1720405665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748613",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848613",
            "telephone_number": "434-295-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15195 HEATHCOTE BLVD STE 240",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201696245",
            "telephone_number": "571-284-3460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Reservoir Rd NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200072113",
            "country_code": "US",
            "telephone_number": "202-295-0560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15225 Heathcote Blvd",
            "address_purpose": "LOCATION",
            "city": "Haymarket",
            "state": "VA",
            "postal_code": "201696264",
            "country_code": "US",
            "telephone_number": "571-284-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8700 Sudley Rd",
            "address_purpose": "LOCATION",
            "city": "Manassas",
            "state": "VA",
            "postal_code": "201104418",
            "country_code": "US",
            "telephone_number": "703-369-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENWALT",
        "first_name": "IAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "DC",
            "license": "MD047318",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101283801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haymarket, VA

Sources for this page

Verify at the official NPI Registry.