NPIMap

Organization Active NPI

The Pediatric Group, PC

  • Pediatric Registered Nurse
  • Lake Ridge, VA
National Provider Identifier
1780808006
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Registered NurseTaxonomy code 163WP0200X
Legal business name
THE PEDIATRIC GROUP, PC
Practice address
12506 A Lake Ridge Drive
Lake Ridge, VA 22192
Phone
(703) 494-4811
NPI assigned
Apr 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael Grader
Title
Administrator
Phone
(703) 971-6900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WP0200X Primary

Addresses

Primary practice location

12506 A Lake Ridge Drive
Lake Ridge, VA 22192

Mailing address

7015 C Manchester Blvd.
Alexandria, VA 22310

National Provider Directory

National Provider Directory
Tax ID family
The Pediatric Group PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

12506 Lake Ridge Dr
Ste A
Lake Ridge, VA 22192
Phone (703) 494-4811

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780808006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7015 C MANCHESTER BLVD.",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "22310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12506 A LAKE RIDGE DRIVE",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-494-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRADER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-971-6900"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Ridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.