NPIMap

Individual provider Active NPI

Jennifer T Wargo, M.D.

  • Diagnostic Radiology Physician
  • Manassas, VA
National Provider Identifier
1790740306
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101230648 Issued in VA
Practice address
8629 Sudley Rd
Suite 102
Manassas, VA 20110-4590
Phone
(703) 361-3030
NPI assigned
Apr 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101230648 VA Primary

Addresses

Primary practice location

8629 Sudley Rd
Suite 102
Manassas, VA 20110-4590

Mailing address

8629 Sudley Rd
Suite 102
Manassas, VA 20110-4590
Phone (703) 361-3030

Other identifiers 6

IdentifierTypeStateIssuer
6688-0021OtherVACAREFIRST
7237529MedicaidVA
7237511MedicaidVA
7237464MedicaidVA
7237456MedicaidVA
7247575MedicaidVA

Other names 1

  • Jennifer Tumulty Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
David L Bloom PA Diagnostic Radiology Past Accepting new patients
David L Bloom PA Diagnostic Radiology Past Accepting new patients
University of Maryland Diagnostic Imaging Specialists P a Diagnostic Radiology Past Accepting new patients
Shenandoah Memorial Hospital, Inc. Past Accepting new patients
University Imaging Center, LLC Diagnostic Radiology Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1790740306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8629 SUDLEY RD",
            "address_2": "SUITE 102",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104590",
            "telephone_number": "703-361-3030",
            "fax_number": "703-361-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8629 SUDLEY RD",
            "address_2": "SUITE 102",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104590",
            "telephone_number": "703-361-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARGO",
        "first_name": "JENNIFER",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101230648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "6688-0021",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7237529",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7237511",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7237464",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7237456",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7247575",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "TUMULTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.