Fernando Manuel Avila, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY31410 Issued in CA

Practice address

2671 Avenir PL
Vienna, VA 22180-7485

Phone

(703) 207-8600

NPI assigned

Aug 29, 2011

Last updated

Jan 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thriveworks Clinical - California PCGroup PAC ID 1759785645, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thriveworks Clinical - California PC

  • Mental Health Counselor
  • Thousand Oaks, CA
  • NPI 1801481395
  Medicare reassignment Care Compare group NPD
• Inova Health Care Services

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1952320061

  DC

  Medicare reassignment NPD
• Memory Check Psychological Services, a Professional Corporation

  • Clinical Psychologist
  • Carlsbad, CA
  • NPI 1912184219
  Medicare reassignment NPD

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1962783464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11125 PELHAM LN",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304518",
            "telephone_number": "626-203-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2671 AVENIR PL",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221807485",
            "telephone_number": "703-207-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILA",
        "first_name": "FERNANDO",
        "middle_name": "MANUEL",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-29",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "RPS 2012468",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005615",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY31410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ara Anthony Avedisian
• Margarita Avedisian, PH.D.
• Arturo Avila-Silva, PT
• Abdallah Awada, D.D.S. M.S.D.
• Ayrielle Williams, LLC
• Az Diabetic Supply Inc
• Amina Azam, OD
• Hassan Azam

• Clinical Psychologist in Vienna, VA
• Providers in Vienna, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.