NPIMap

Organization Active NPI

Family Medicine in Falls Church PC

  • Family Medicine Physician
  • Falls Church, VA
National Provider Identifier
1952474306
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101102617 Issued in VA
Legal business name
FAMILY MEDICINE IN FALLS CHURCH PC
Practice address
124 E Broad St Ste a
Falls Church, VA 22046-4530
Phone
(703) 533-7555
Fax
(703) 533-7797
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Dr. Gordon Walker Theisz, M.D.NPI 1437101508
Title
President
Phone
(703) 533-7555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0101102617 VA Primary

Addresses

Primary practice location

124 E Broad St Ste a
Falls Church, VA 22046-4530

Mailing address

124 E Broad St Ste a
Falls Church, VA 22046-4530
Phone (703) 533-7555

Other practice location 1

104A E Broad St
Falls Church, VA 22046-4501
Phone (703) 533-7555

Other practice location 2

104A E Broad St
Falls Church, VA 22046-4501
Phone (703) 533-7555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051006000299 DC Part B Supplier - Clinic/Group Practice 4688699945 Receives reassigned benefits from 7 practitioners
Practice locations: Falls Church, VA

National Provider Directory

National Provider Directory

Locations

124 E Broad St
Ste A
Falls Church, VA 22046
Phone (703) 533-7555

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1952474306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 E BROAD ST STE A",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220464530",
            "telephone_number": "703-533-7555",
            "fax_number": "703-533-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E BROAD ST STE A",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220464530",
            "telephone_number": "703-533-7555",
            "fax_number": "703-533-7797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104A E Broad St",
            "address_purpose": "LOCATION",
            "city": "Falls Church",
            "state": "VA",
            "postal_code": "220464501",
            "country_code": "US",
            "telephone_number": "703-533-7555",
            "fax_number": "703-533-7797",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104A E Broad St",
            "address_purpose": "LOCATION",
            "city": "Falls Church",
            "state": "VA",
            "postal_code": "220464501",
            "country_code": "US",
            "telephone_number": "703-533-7555",
            "fax_number": "703-533-7797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY MEDICINE IN FALLS CHURCH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "THEISZ",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "WALKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-533-7555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101102617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falls Church, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.