NPIMap

Organization Active NPI

Ace Physical Therapy & Sports Medicine Institute, LLC

  • Physical Therapist
  • Herndon, VA
National Provider Identifier
1821033564
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305004004 Issued in VA
Legal business name
ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC
Practice address
108 Elden St.
Suite 12
Herndon, VA 20170-4876
Phone
(703) 205-1233
Fax
(703) 641-0189
NPI assigned
Jun 17, 2006
Last updated
Apr 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

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

Authorized official

Name
Michael A Ercole, PTNPI 1477510071
Title
Director/Owner
Phone
(703) 205-1233

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305004004 VA Primary

Addresses

Primary practice location

108 Elden St.
Suite 12
Herndon, VA 20170-4876

Mailing address

2841 Hartland Rd
Suite 401B
Falls Church, VA 22043
Phone (703) 205-1233

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070301000072 DC Part B Supplier - Clinic/Group Practice 3173625787 Receives reassigned benefits from 12 practitioners
6 other NPIs on this enrollment
Practice locations: Herndon, VA; Vienna, VA; Falls Church, VA; Arlington, VA; Alexandria, VA; Fairfax, VA
O20091221000391 VA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3173625787 Receives reassigned benefits from 7 practitioners
Practice locations: Falls Church, VA; Herndon, VA; Leesburg, VA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ace Physical Therapy Sports9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

2841 Hartland Rd
Falls Church, VA 22043
Phone (703) 774-3132

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428969600000",
    "number": "1821033564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 HARTLAND RD",
            "address_2": "SUITE 401B",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "22043",
            "telephone_number": "703-205-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 ELDEN ST.",
            "address_2": "SUITE 12",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704876",
            "telephone_number": "703-205-1233",
            "fax_number": "703-641-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2015-04-14",
        "status": "A",
        "authorized_official_last_name": "ERCOLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "703-205-1233",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305004004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.