CCRM Northern Virginia, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CCRM NORTHERN VIRGINIA, LLC

Practice address

8010 Towers Crescent Dr FL 5
Vienna, VA 22182-2710

Phone

(571) 789-2100

NPI assigned

Feb 25, 2020

Organization subpart

No

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

Authorized official

Name

Matt Tyson

Title

Director, Managed Care Contracting

Phone

(615) 477-6677

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

CCRM Northern Virginia2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CCRM Northern Virginia, LLC

  • Ambulatory Fertility Facility
  • Vienna, VA
  • NPI 1598297269
  NPD tax ID

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1770117095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8010 TOWERS CRESCENT DR FL 5",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8010 TOWERS CRESCENT DR FL 5",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822710",
            "telephone_number": "571-789-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRM NORTHERN VIRGINIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "DIRECTOR, MANAGED CARE CONTRACTING",
        "authorized_official_telephone_number": "615-477-6677"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "49D2129549",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebeca Esmaralda Castro
• Cataract Vision Institute Virginia LLC
• Ashley Shea Catlin, FNP
• Gayla Sue Cauldwell, ARNP-C
• CCRM Northern Virginia, LLC
• CCRM Virginia LLC
• Center for Medical Dermatology
• Center for Skin Surgery PLLC
• Center for Skin Surgery PLLC
• Centers for Advanced Orthopaedics, LLC

• Clinical Medical Laboratory in Vienna, VA
• Providers in Vienna, VA by specialty
• Clinical Medical Laboratory in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.