NMG Affiliate Practice I, LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

NMG AFFILIATE PRACTICE I, LLC

Practice address

25055 Riding PLZ
Suite 230
South Riding, VA 20152-5917

Phone

(703) 361-3551

Fax

(703) 365-7702

NPI assigned

Jul 16, 2013

Organization subpart

No

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

Authorized official

Name

Geoffrey K Gardner

Title

VP of Finance

Phone

(571) 261-3529

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Novant Health UVA Health System Lake Manassas OB/GYN Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 5

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

• Christopher Scott Ennen, MD

  • Maternal & Fetal Medicine Physician
  • Charlottesville, VA
  • NPI 1407836646

  Obstetrics & Gynecology

  NPD
• Faraz Masood, MD

  • Hospitalist Physician
  • South Chesterfield, VA
  • NPI 1609071661
  NPD
• Ann E Radford, DO

  • Psychiatry Physician
  • Manassas, VA
  • NPI 1508849456
  NPD
• Janice Soliven, M.D.

  • Family Medicine Physician
  • Bristow, VA
  • NPI 1346536075
  NPD
• Scott A Ross, MD

  • Family Medicine Physician
  • Myrtle Beach, SC
  • NPI 1841290129
  NPD

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1922449263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "703-361-3551",
            "fax_number": "703-365-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25055 RIDING PLZ",
            "address_2": "SUITE 230",
            "city": "SOUTH RIDING",
            "state": "VA",
            "postal_code": "201525917",
            "telephone_number": "703-361-3551",
            "fax_number": "703-365-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NMG AFFILIATE PRACTICE I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-16",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "571-261-3529"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922449263",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health UVA Health System Lake Manassas OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary K Home Health Care
• Molly Chaloner Mastoras, LPC
• Julie Morrow
• Anna Murphy, D.D.S.
• Linh Nguyen, D.D.S.
• Nova Behavioral Health and Wellness
• Pediatric Dentistry of South Riding
• Pediatric Therapy Services of Loudoun County
• Melissa Marie Peters, LCSW
• Wayne Oliver Powell, LPC

• All providers in South Riding, VA
• Obstetrics & Gynecology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.