Vine Psychiatric Associates, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

VINE PSYCHIATRIC ASSOCIATES, LLC

Practice address

14631 Route 29 Ste 209
Centreville, VA 20121-5827

Phone

(703) 830-1800

Fax

(703) 830-1800

NPI assigned

Sep 29, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Young Hoon Bae, M.D.NPI 1619931680

Title

Owner

Phone

(703) 830-1800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Young Hoon Bae, MD

  • Psychiatry Physician
  • Centreville, VA
  • NPI 1619931680

  DC

  Medicare reassignment Authorized official
• Peter Whang, LPC, PBSF

  • Professional Counselor
  • Fairfax, VA
  • NPI 1407246127
  NPD

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

{
    "created_epoch": "1538179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1891270435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14631 ROUTE 29 STE 209",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201215827",
            "telephone_number": "703-830-1800",
            "fax_number": "703-830-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14631 ROUTE 29 STE 209",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201215827",
            "telephone_number": "703-830-1800",
            "fax_number": "703-830-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE PSYCHIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-29",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_middle_name": "HOON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-830-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Centreville, VA
• Providers in Centreville, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.