Individual provider Active NPI

Jessica Freedman, PA-C, ATC

  • Physician Assistant
  • Reston, VA
National Provider Identifier
1851967541
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110007907 Issued in VA
Practice address
11800 Sunrise Valley Dr FL 8
Reston, VA 20191-5300
Phone
(703) 709-1114
NPI assigned
Jun 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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 0110007907 VA Primary

Addresses

Primary practice location

11800 Sunrise Valley Dr FL 8
Reston, VA 20191-5300

Mailing address

11800 Sunrise Valley Dr Ste 800
Reston, VA 20191-5320
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
I20210914000903 DC Practitioner - Physician Assistant 8325444581 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1715 N George Mason Dr
Suite 504
Arlington, VA 22205-3670
Phone (703) 525-2200

Hospital & facility affiliations

  • Virginia Hospital Center Hospital, Arlington, VA, CCN 490050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110007907VAMDPhysician Assistant

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1851967541",
    "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",
            "fax_number": "703-709-6646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR FL 8",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915300",
            "telephone_number": "703-709-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEDMAN",
        "first_name": "JESSICA",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.