Mavis A Agyeiwaah, MD
Individual provider Active NPI Family Medicine Physician · Winchester, VA
NPI 1902218944 · NPPES record last updated Jul 23, 2024
Key facts
- NPI
- 1902218944
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101256459 (VA)
- Practice address
- 1440 Amherst St
Winchester, VA 22601-3010 - Phone
- (540) 536-5400
- Fax
- (540) 536-5490
- NPI assigned
- May 26, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 21
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Howard University College of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kaiser Foundation Health Plan of the Mid Atlantic States, Inc
Practice addresses (Care Compare)
1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700
5100 Auth Way
Suitland, MD 20746-4207
Phone (301) 702-5000
6104 Old Branch Ave
Temple Hills, MD 20748-2518
Phone (301) 702-6100
6551 Loisdale CT
Springfield, VA 22150-1828
Phone (703) 922-1000
Hospital & facility affiliations
- Human Touch Home Health of Maryland, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200311002804 | VA | Practitioner - Family Practice | 8628374659 | Reassigns benefits to 1 organization |
| I20250525000024 | DC | Practitioner - Family Practice | 8628374659 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 267-601-1 | NY | MD | Family Medicine Physician |
| 0101256459 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Physician Enterprise, Inc | Family Medicine | Current | Accepting new patients |
| Valley Physician Enterprise, Inc. | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Family Medicine | Current | Accepting new patients |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients | |
| Valley Physician Enterprise, Inc. | Current |
Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current |
Accepting new patients |
Locations
4000 Garden City Dr
Fl 4
Hyattsville, MD 20785
Phone (227) 229-8532
1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500
1000 N Shenandoah Ave
Front Royal, VA 22630
Phone (540) 636-0300
611 E Jubal Early Dr
Winchester, VA 22601
Phone (540) 536-5500
1440 Amherst St
Winchester, VA 22601
Phone (540) 450-3339
160 Merchant St
Ste 160
Winchester, VA 22603
160 Merchant St
#100
Winchester, VA 22603
Phone (540) 536-5400
220 Campus Blvd
Ste 100
Winchester, VA 22601
Interoperability endpoints
- magyeiwaah679681@soc.inova.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 267-601-1 | NY | |
| Family Medicine Physician | 207Q00000X | 0101256459 | VA | Yes |
Addresses
Primary practice location
1440 Amherst St
Winchester, VA 22601-3010
Mailing address
5060 Valley View Blvd NW
Roanoke, VA 24012-2038
Other practice location 1
611 E Jubal Early Dr
Winchester, VA 22601-5178
Phone (540) 536-5500
Other practice location 2
5060 Valley View Blvd NW
Roanoke, VA 24012-2038
Phone (888) 338-4579
Other practice location 3
160 Merchant St Ste 100
Winchester, VA 22603-4772
Phone (540) 536-5560
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | magyeiwaah679681@soc.inova.org | ||
| Direct Messaging Address | magyeiwaah679681@soc.inova.org | ||
| Direct Messaging Address | magyeiwaah679681@soc.inova.org | ||
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) |
Other providers in Winchester, VA
- Shanzeh Aftab
- Gaurav Agarwal
- Rebecca Agbayani
- George C Agritellis
- Genesis Aguila
- Tahmid Ahmed
- Susan Elizabeth Aicardi
- AIDS Response Effort, Inc
- Kamille Leslie Aiello
- Opeoluwa Ajibike
All providers in Winchester, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2024. 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.
- Order and Referring (CMS).
- 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.