Individual provider Active NPI

John L Antus, MD

  • Internal Medicine Physician
  • Manassas, VA
National Provider Identifier
1740241314
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101023164 Issued in VA
Practice address
9306 Forest Point Cir
Manassas, VA 20110-4700
Phone
(703) 330-3322
Fax
(703) 330-5051
NPI assigned
Mar 31, 2006
Last updated
Oct 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101023164 VA Primary

Addresses

Primary practice location

9306 Forest Point Cir
Manassas, VA 20110-4700

Mailing address

9306 Forest Point Cir
Manassas, VA 20110-4700
Phone (703) 330-3322

Other identifiers 1

IdentifierTypeStateIssuer
6049311MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040903000094 VA Practitioner - Internal Medicine 1456327212 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101023164VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Arun K Gupta PC CurrentSince May 1, 2010 Accepting new patients
Medical Eye Care Associates, PC PastSince Feb 1, 2010 Accepting new patients

Locations

9306 Forest Point Cir
Manassas, VA 20110
Phone (703) 330-3322

Interoperability endpoints

  • Direct secure messaging: john.antus.1@18665.direct.athenahealth.com

Organizations & group practices 2

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1740241314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9306 FOREST POINT CIR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104700",
            "telephone_number": "703-330-3322",
            "fax_number": "703-330-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9306 FOREST POINT CIR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104700",
            "telephone_number": "703-330-3322",
            "fax_number": "703-330-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTUS",
        "first_name": "JOHN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101023164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6049311",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

Verify at the official NPI Registry.