NPIMap

Organization Active NPI

Benjamin a. Adewale MD PC

Doing business as Riverside Mental and Medical Clinic

  • Mental Health Counselor
  • Alexandria, VA
National Provider Identifier
1992073084
Registry record updated Jul 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MD22004 Issued in DC
Legal business name
BENJAMIN A. ADEWALE MD PC
Doing business as
Riverside Mental and Medical Clinic
Practice address
25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585
Phone
(571) 257-4398
Fax
(703) 823-4407
NPI assigned
Dec 5, 2011
Last updated
Jul 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2013

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

Authorized official

Name
Dr. Benjamin Adewale, M.D.NPI 1790702132
Title
Ceo
Phone
(703) 569-8028

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
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X MD22004 DC Primary

Addresses

Primary practice location

25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585

Mailing address

25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585
Phone (571) 257-4398

Other names 1

  • Riverside Mental and Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130805000799 DC Part B Supplier - Clinic/Group Practice 2961469176 Receives reassigned benefits from 1 practitioner
Practice locations: Springfield, VA; Alexandria, VA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

25 S Quaker Ln
Ste 35
Alexandria, VA 22314
Phone (571) 257-4398

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1992073084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S QUAKER LN",
            "address_2": "SUITE 4",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144585",
            "telephone_number": "571-257-4398",
            "fax_number": "703-823-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S QUAKER LN",
            "address_2": "SUITE 4",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144585",
            "telephone_number": "571-257-4398",
            "fax_number": "703-823-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN A. ADEWALE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "ADEWALE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-569-8028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "DC",
            "license": "MD22004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Mental and Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; 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.