NPIMap

Organization Active NPI

Privia Care Center LLC

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1730664012
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRIVIA CARE CENTER LLC
Practice address
301 Saint Paul St Ste 409
Baltimore, MD 21202-2102
Phone
(571) 366-8850
NPI assigned
Oct 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

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

Authorized official

Name
Courtney Ainsworth Ivess
Title
Associate Director, Credentialing
Phone
(571) 366-8831

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

301 Saint Paul St Ste 409
Baltimore, MD 21202-2102

Mailing address

950 N Glebe Rd Ste 4000
Arlington, VA 22203-1824
Phone (157) 198-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170616001775 DC Part B Supplier - Clinic/Group Practice 3274801139 Receives reassigned benefits from 262 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glenn Dale, MD; Gaithersburg, MD; Greenbelt, MD; Herndon, VA; Olney, MD; Rockville, MD; Silver Spring, MD; Washington, DC…
O20170619000055 MD Part B Supplier - Clinic/Group Practice 3274801139 Receives reassigned benefits from 388 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2700 Quarry Lake Dr
Ste 350
Baltimore, MD 21209
Phone (410) 653-0073

602 S Atwood Rd
Bel Air, MD 21014
Phone (410) 223-2616

405 Frederick Rd
Ste 210
Catonsville, MD 21228
Phone (410) 788-6565

56 Thomas Johnson Dr
Ste 200
Frederick, MD 21702
Phone (301) 694-3111

230 W Patrick St
Frederick, MD 21701
Phone (240) 215-6370

56 Thomas Johnson Dr
Ste 102
Frederick, MD 21702
Phone (301) 694-3111

15200 Shady Grove Rd
Ste 320
Rockville, MD 20850
Phone (301) 917-2185

1 Kings Dr
Taneytown, MD 21787
Phone (410) 751-1111

12070 Old Line Ctr
Ste 302
Waldorf, MD 20602
Phone (301) 645-6667

10200 Coppermine Rd
Woodsboro, MD 21798
Phone (301) 845-6322

Practitioners & affiliated clinicians

Practitioners 556

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

View all 556

NPI Registry JSON

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

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538438400000",
    "number": "1730664012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 4000",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031824",
            "telephone_number": "157-198-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SAINT PAUL ST STE 409",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022102",
            "telephone_number": "571-366-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A",
        "authorized_official_last_name": "IVESS",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_middle_name": "AINSWORTH",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR, CREDENTIALING",
        "authorized_official_telephone_number": "571-366-8831"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.