Individual provider Active NPI

William Carl Stallard, M.D.

  • Family Medicine Physician
  • Fairfax, VA
National Provider Identifier
1740694561
Registry record updated May 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0116027266 Issued in VA
Practice address
3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710
Phone
(703) 391-2020
NPI assigned
Jun 19, 2014
Last updated
May 31, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116027266 VA Primary

Addresses

Primary practice location

3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710

Mailing address

3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710
Phone (703) 391-2020

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA, MD3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20160108000067 DC Practitioner - Family PracticePractitioner - Internal Medicine 5092017012 Reassigns benefits to 2 organizations
I20201019000087 VA Practitioner - Family Practice 5092017012 Reassigns benefits to 1 organization
I20210622000689 MD Practitioner - Family Practice 5092017012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, shared by 17 NPIs, 1,921 clinicians

Practice addresses (Care Compare)

43480 Yukon Dr
Suite 100
Ashburn, VA 20147-6988
Phone (571) 252-6000

4920 Campbell Blvd
Nottingham, MD 21236-5916
Phone (410) 933-7600

6551 Loisdale CT
Springfield, VA 22150-1828
Phone (703) 922-1000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC Family Medicine CurrentSince Nov 11, 2015 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Mar 17, 2021 Accepting new patients
Privia Medical Group, LLC CurrentSince Nov 11, 2015 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Family Medicine CurrentSince Aug 4, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 4, 2017 Accepting new patients

Locations

7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

4920 Campbell Blvd
Nottingham, MD 21236
Phone (410) 933-7600

2101 E Jefferson St
#4E
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
Ste 6
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

43480 Yukon Dr
Ste 100
Ashburn, VA 20147
Phone (571) 252-6000

3650 Joseph Siewick Dr
Ste 400
Fairfax, VA 22033
Phone (703) 391-2020

6551 Loisdale Ct
Springfield, VA 22150
Phone (571) 622-2100

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 7

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": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1740694561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLARD",
        "first_name": "WILLIAM",
        "middle_name": "CARL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116027266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3650 Joseph Siewick Dr",
            "address_2": "Suite 400",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220331710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.