NPIMap

Organization Active NPI

Prime Care Family Practice, P.C.

  • Family Medicine Physician
  • Prince George, VA
National Provider Identifier
1881629384
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIME CARE FAMILY PRACTICE, P.C.
Practice address
4700 Puddledock Road
Suite 300
Prince George, VA 23875-1268
Phone
(804) 526-1111
Fax
(804) 526-8363
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Ms. Deidra F. Mann
Title
Practice Manager
Phone
(804) 526-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4700 Puddledock Road
Suite 300
Prince George, VA 23875-1268

Mailing address

4700 Puddledock Road
Suite 300
Prince George, VA 23875-1268
Phone (804) 526-1111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050225000611 VA Part B Supplier - Clinic/Group Practice 5799738035 Receives reassigned benefits from 7 practitioners
Practice locations: Prince George, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2096506Prime Care Family Practice4700 Puddledock Road - Suite 300, Prince George, VA 23875Certificate of waiverMay 26, 2027

National Provider Directory

National Provider Directory

Locations

4700 Puddledock Rd
Ste 300
Prince George, VA 23875
Phone (804) 526-1111

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HGEACA

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1881629384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 PUDDLEDOCK ROAD",
            "address_2": "SUITE 300",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751268",
            "telephone_number": "804-526-1111",
            "fax_number": "804-526-8363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 PUDDLEDOCK ROAD",
            "address_2": "SUITE 300",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751268",
            "telephone_number": "804-526-1111",
            "fax_number": "804-526-8363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE FAMILY PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "DEIDRA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "804-526-1111",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince George, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.