NPIMap

Organization Active NPI

Benjamin Adewale MD PC

Doing business as Riverside Mental Health LLC

  • Neurology Physician
  • Springfield, VA
National Provider Identifier
1821015264
Registry record updated Jan 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BENJAMIN ADEWALE MD PC
Doing business as
Riverside Mental Health LLC
Practice address
7011 Calamo St
#105
Springfield, VA 22150
Phone
(703) 569-8028
Fax
(703) 569-8085
NPI assigned
Jul 15, 2006
Last updated
Jan 17, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
BENJAMIN A. ADEWALE MD PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2018

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

Authorized official

Name
Benjamin Adyson Adenwale, MD
Title
Medical Director MD
Phone
(703) 569-8028

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
VA Clinic/Center 261QV0200X 0101054165 VA
Nurse Practitioner 363L00000X NU
Neurology Physician 2084N0400X NU Primary
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

7011 Calamo St
#105
Springfield, VA 22150

Mailing address

PO Box 8057
Alexandria, VA 22306-8057

Other names 1

  • Riverside Mental Health LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000115 VA Part B Supplier - Clinic/Group Practice 2961469176 Receives reassigned benefits from 1 practitioner
Practice locations: Woodbridge, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Benjamin a Adewale MD P

Locations

25 S Quaker Ln
Alexandria, VA 22314

7011 Calamo St
Ste 105
Springfield, VA 22150
Phone (703) 569-8028

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516147200000",
    "number": "1821015264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8057",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223068057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7011 CALAMO ST",
            "address_2": "#105",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "22150",
            "telephone_number": "703-569-8028",
            "fax_number": "703-569-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN ADEWALE MD PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BENJAMIN A. ADEWALE MD PC",
        "enumeration_date": "2006-07-15",
        "last_updated": "2018-01-17",
        "status": "A",
        "authorized_official_last_name": "ADENWALE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "ADYSON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR MD",
        "authorized_official_telephone_number": "703-569-8028",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "VA",
            "license": "0101054165",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Mental Health LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.