NPIMap

Organization Active NPI

Erickson Health Medical Group of Virginia PC

  • Internal Medicine Physician
  • Ashburn, VA
National Provider Identifier
1871759340
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ERICKSON HEALTH MEDICAL GROUP OF VIRGINIA PC
Practice address
21170 Ashby Ponds Blvd
Ashburn, VA 20147
Phone
(571) 291-6131
Fax
(571) 291-6135
NPI assigned
Aug 4, 2008
Last updated
Aug 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Authorized official

Name
Dr. Matthew J Narrett, M.D.
Title
Senior VP and Chief Medical Officer
Phone
(410) 402-2257

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X NU
Gerontology Nurse Practitioner 363LG0600X NU
Gerontology Clinical Nurse Specialist 364SG0600X NU
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X NU
Family Medicine Physician 207Q00000X NU
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU
Internal Medicine Physician 207R00000X NU Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU
Podiatrist 213E00000X NU

Addresses

Primary practice location

21170 Ashby Ponds Blvd
Ashburn, VA 20147

Mailing address

5730 Executive Dr Ste 230
Catonsville, MD 21228-1762
Phone (571) 291-6131

Other names 1

  • Ashby Ponds Medical Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090310000070 VA Part B Supplier - Clinic/Group Practice 1153314067 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
Practice locations: Ashburn, VA; Richmond, VA

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Senior Campus Care LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1871759340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 EXECUTIVE DR STE 230",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212281762",
            "telephone_number": "571-291-6131",
            "fax_number": "571-291-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21170 ASHBY PONDS BLVD",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "20147",
            "telephone_number": "571-291-6131",
            "fax_number": "571-291-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON HEALTH MEDICAL GROUP OF VIRGINIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "NARRETT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VP AND CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "410-402-2257",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ashby Ponds Medical Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ashby Ponds Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ashburn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.