Orthovirginia Inc.
Organization Active NPI Multi-Specialty Clinic/Center · Aldie, VA
NPI 1871136622 · NPPES record last updated Aug 17, 2023
Key facts
- NPI
- 1871136622
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- ORTHOVIRGINIA INC.
- Practice address
- 24600 Millstream Dr Ste 380
Aldie, VA 20105-5686 - Phone
- (703) 810-5241
- Fax
- (571) 407-5689
- NPI assigned
- Oct 24, 2019
- Organization subpart
- No
Authorized official
- Name
- Nicole Proffitt
- Title
- Credentialing/Enrollment
- Phone
- (804) 533-2357
Other NPIs on the same Medicare enrollment 51
Corporate family (same tax ID) 22
Practitioners 7
-
Tim D Dominick, PA-C
-
John Donald Duerden, M.D.
-
Rebecca M Ellen, PA
-
Amanda R Graupman, PA-C
-
Sarah A Kibbe, ORT/L, CHT, CPAM
-
Diana Zhi-Hong Lien, DPT
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Orthovirginia, Inc. |
Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in VA, DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040228000320 | VA | Part B Supplier - Clinic/Group Practice | 0547157224 |
Receives reassigned benefits from 546 practitioners 30 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mechanicsville, VA; Midlothian, VA; North Chesterfield, VA; Prince George, VA; Richmond, VA; Virginia Beach, VA; Wytheville, VA; Manassas, VA… |
| O20150102000273 | DC | Part B Supplier - Clinic/Group Practice | 0547157224 |
Receives reassigned benefits from 252 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Alexandria, VA; Reston, VA; McLean, VA; MC Lean, VA; Herndon, VA; Fairfax, VA; Burke, VA; Arlington, VA |
| O20200505002989 | VA | DME Supplier - Multi-Specialty - Physician |
0547157224 | Practice locations: Aldie, VA |
National Provider Directory
- Tax ID family
- Orthovirginia
Locations
1717 Will O Wisp Dr
Ste 100
Virginia Beach, VA 23454
Phone (757) 422-8476
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes | ||
| Physical Therapy Clinic/Center | 261QP2000X | |||
| Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X |
Addresses
Primary practice location
24600 Millstream Dr Ste 380
Aldie, VA 20105-5686
Mailing address
PO Box 715868
Philadelphia, PA 19171-5868
Phone (804) 915-1910
Other providers in Aldie, VA
- Novacare and Support LLC
- Jesse Ntawutarama
- Crystal Nwannunu
- Teresa Ojode
- Rebecca Orbeta
- Renee Packer-Lowe
- Erlinda Cruz Paguio
- Edward Park
- Gayatri Patel
- Lauren Pepe
All providers in Aldie, VA · Multi-Specialty Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.