Individual provider Active NPI

Juan C Ortiz Perez, M.D.

  • Adult Medicine Physician
  • Woodbridge, VA
National Provider Identifier
1992118061
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
0101261727 Issued in VA
Practice address
14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone
(703) 359-7878
NPI assigned
Jun 6, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X 0101261727 VA Primary

Addresses

Primary practice location

14139 Potomac Mills Rd
Woodbridge, VA 22192-4644

Mailing address

14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone (703) 359-7878

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171103000424 VA Practitioner - Internal MedicinePractitioner - Family Practice 8325304512 Reassigns benefits to 1 organization
I20210617000087 DC Practitioner - Family Practice 8325304512 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14139 Potomac Mills Rd
Woodbridge, VA 22192-4644
Phone (703) 257-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Multi-Specialty CurrentSince Aug 15, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 15, 2017 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Multi-Specialty Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Mar 13, 2021 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2101 E Jefferson St
Ste 6
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1992118061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14139 POTOMAC MILLS RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924644",
            "telephone_number": "703-359-7878",
            "fax_number": "804-739-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14139 POTOMAC MILLS RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924644",
            "telephone_number": "703-359-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ PEREZ",
        "first_name": "JUAN",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-06",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "VA",
            "license": "0101261727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "14139 Potomac Mills Rd",
            "city": "Woodbridge",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221924644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.