McLean Tysons Orthopedic Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MCLEAN TYSONS ORTHOPEDIC SURGERY CENTER, LLC

Practice address

1760 Old Meadow Rd
MC Lean, VA 22102-4331

Phone

(860) 667-9542

NPI assigned

Apr 29, 2021

Last updated

Apr 29, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lucille Formeister

Title

Dir. Bus Systems

Phone

(860) 667-9542

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Listed as

McLean Tysons Orthopedic Surgery Center LLCCCN 49C0001102

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Virginia Hospital Center Arlington Health System

  • Psychiatric Hospital Unit
  • Arlington, VA
  • NPI 1104075704

  Member Of

  NPD member

Locations

Practitioners 2

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.

• Ronald C Childs, MD

  • Orthopaedic Surgery Physician
  • McLean, VA
  • NPI 1154343986
  NPD (past)
• Richard Mark Grossman, M.D.

  • Orthopaedic Surgery Physician
  • Boca Raton, FL
  • NPI 1871607465
  NPD (past)

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1942883764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 OLD MEADOW RD",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024331",
            "telephone_number": "860-667-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 OLD MEADOW RD",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024331",
            "telephone_number": "860-667-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEAN TYSONS ORTHOPEDIC SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-29",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A",
        "authorized_official_last_name": "FORMEISTER",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_title_or_position": "DIR. BUS SYSTEMS",
        "authorized_official_telephone_number": "860-667-9542"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McLean Pharmacy Inc
• McLean Physical Therapy & Rehab Services, LLC.
• McLean Psychiatric Services LLC
• McLean Rhinoplasty
• McLean Rhinoplasty, ENT & Sinus PLLC
• Darius McLean, PA-C
• Michele McLellan, PT
• Doreen Ella McMahon, MD
• Katherine McMorrow
• Kelly Carroll McQueen, AUD, CCC-A

• Ambulatory Surgical Clinic/Center in McLean, VA
• Providers in McLean, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.