Individual provider Active NPI

Ian Campbell Brown, PA-C

  • Physician Assistant
  • Reston, VA
National Provider Identifier
1821538356
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110-005684 Issued in VA
Practice address
11800 Sunrise Valley Dr Ste 800
Reston, VA 20191
Phone
(703) 709-1114
NPI assigned
Mar 2, 2017
Last updated
Aug 3, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110-005684 VA Primary

Addresses

Primary practice location

11800 Sunrise Valley Dr Ste 800
Reston, VA 20191

Mailing address

11800 Sunrise Valley Dr Ste 800
Reston, VA 20191-5320
Phone (703) 709-1114

Other practice location 1

1831 Wiehle Ave
#200
Reston, VA 20190-5266
Phone (703) 709-1114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171012001737 DC Practitioner - Physician Assistant 4385919653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Spine Institute PLCGroup PAC ID 1951396225, 11 clinicians

Practice addresses (Care Compare)

11800 Sunrise Valley Dr
Suite 800
Reston, VA 20191-5300
Phone (703) 709-1114

Merit-based Incentive Payment System (MIPS)

Final score
83.93 of 100Reported as group
Quality
70.87
Promoting interoperability
100
Improvement activities
40
Cost
75.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0110-005684VAMDPhysician Assistant

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533254400000",
    "number": "1821538356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR STE 800",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915320",
            "telephone_number": "703-709-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR STE 800",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20191",
            "telephone_number": "703-709-1114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1831 Wiehle Ave",
            "address_2": "#200",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201905266",
            "country_code": "US",
            "telephone_number": "703-709-1114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "IAN",
        "middle_name": "CAMPBELL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-02",
        "last_updated": "2018-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-005684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.