PRIVIA MEDICAL GROUP, LLC (NPI# 1558919134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558919134 |
| Entity Type | Organization |
| Organization Name | PRIVIA MEDICAL GROUP, LLC |
| Practice Address |
104a E Broad St Ste A Falls Church VA 22046-4501 |
| Mailing Address |
950 N Glebe Rd Ste 700 Arlington VA 22203-4173 |
| Practice Telephone | 7032371555 |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |
| Authorized Official Name | COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING) |
| Authorized Official Telephone | 5713668831 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP1100X |
Clinic/Center Specialization: Podiatric |
Ambulatory Health Care Facilities | ||
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| Falls Church Foot and Ankle Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154961316 | Privia Medical Group, LLC | Internal Medicine | 24560 Southpoint Dr Ste 200, Aldie, VA 20105-3505 | 2020-01-15 |
| 1013042480 | Privia Medical Group, LLC | Pediatrics | 950 N Glebe Rd, Suite 4000, Arlington, VA 22203-1824 | 2007-02-23 |
| 1861099541 | Privia Medical Group, LLC | Family Medicine | 14300 Gallant Fox Ln Ste 222, Bowie, MD 20715-4033 | 2020-10-06 |
| 1962053306 | Privia Medical Group, LLC | Podiatrist | 8988 Lorton Station Blvd Ste 100, Lorton, VA 22079-4757 | 2019-09-26 |
| 1316598758 | Privia Medical Group, LLC | Podiatrist | 8109 Hinson Farm Rd Ste 504, Alexandria, VA 22306-3411 | 2019-09-26 |
| 1225689698 | Privia Medical Group, LLC | Podiatrist | 6128 Brandon Ave Ste 201, Springfield, VA 22150-2693 | 2019-09-26 |
| 1093251209 | Privia Medical Group, LLC | Family Medicine | 950 N Glebe Rd, Suite 4000, Arlington, VA 22203-1824 | 2017-01-11 |
| 1881138261 | Privia Medical Group, LLC | Internal Medicine | 1616 Forest Dr, Suite 1, Annapolis, MD 21403-1019 | 2016-12-05 |
| 1265975924 | Privia Medical Group, LLC | Internal Medicine | 7625 Wisconsin Ave, Suite 101, Bethesda, MD 20814-6512 | 2016-11-29 |
| 1487105946 | Privia Medical Group, LLC | Podiatrist | 1201 Seven Locks Rd, Suite 202, Rockville, MD 20854-2931 | 2016-10-20 |
| Street Address |
104A E BROAD ST STE A |
| City | FALLS CHURCH |
| State | VA |
| Zip Code | 22046-4501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831735794 | Megan Katherine Hassan | Speech-Language Pathologist | 803 West Broad Street, Suite 100, Falls Church, VA 22046 | 2019-11-25 |
| 1205481173 | Michael William Wirtz | Physical Therapist | 510 South Washington Street, Ste. A, Falls Church, VA 22046 | 2019-08-07 |
| 1629636568 | Meaghan A Souza | Physical Therapist | 510 S Washington Street, Suite A, Falls Church, VA 22046 | 2019-06-05 |
| 1619478963 | Teresa Rosas | Dentist | Blvd Fundadores #8417-21, Tijuana, BAJA CALIFORNIA 22046 | 2018-02-22 |
| 1174022974 | Bio Medical Center | Radiology | 3170 General Ferreira, Colonia Madero Sur, Tijuana, BAJA CALIFORNIA 22046 | 2018-02-07 |
| 1558875385 | M & R Taxi Company, Inc. | Non-emergency Medical Transport (VAN) | 1115 West Broad St., Falls Church, VA 22046 | 2017-12-01 |
| 1356860829 | Neurology | Neuromusculoskeletal Medicine & OMM | 701 W Broad St Ste 214, Falls Church, VA 22046 | 2017-09-15 |
| 1184140501 | Christopher Grivas | Chiropractor | 510 W Annandale Road, Suite 300, Falls Church, VA 22046 | 2017-08-17 |
| 1831562719 | Strategy Anesthesia Virginia, LLC | Anesthesiology | 502 W Broad Street (route 7), Falls Church, VA 22046 | 2015-11-02 |
| 1851762025 | Edward A Stern | Registered Nurse | 201 N Washington Street, C/o Kaiser Permanente, Falls Church, VA 22046 | 2015-10-14 |
| Find all providers in zip 22046 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609431964 | Ana Anahit Emirzian | Podiatrist | 3300 Gallows Road, Original Building, Falls Church, VA 22042-3307 | 2019-05-02 |
| 1740285022 | Paul B Cannon | Podiatrist | 104a E Broad St, Falls Church, VA 22046-4501 | 2005-06-14 |
| 1992360226 | Sean Robert Lyons | Podiatrist | 3300 Gallows Rd, Falls Church, VA 22042-3307 | 2019-05-02 |
| 1306257027 | Ankita Dharia | Podiatrist | 104a E Broad St, Falls Church, VA 22046-4501 | 2014-05-15 |
| 1295179182 | Ton Q. Ho | Podiatrist | 6408 Seven Corners Pl, Suite C, Falls Church, VA 22044-2011 | 2013-04-22 |
| 1265782080 | Strong Foundations Foot and Ankle Center, Pllc | Podiatrist | 510 W Annandale Rd, Falls Church, VA 22046-4226 | 2012-09-19 |
| 1932462371 | James P Callahan | Podiatrist | 3300 Gallows Rd, Falls Church, VA 22042-3307 | 2012-06-20 |
| 1932461936 | Anthony Joseph Cavallo | Podiatrist | 3300 Gallows Rd, Falls Church, VA 22042-3307 | 2012-06-14 |
| 1285929257 | Joanna Wyman | Podiatrist | 3300 Gallows Rd, Falls Church, VA 22042-3307 | 2011-06-17 |
| 1639497324 | Arthur Williamson Black | Podiatrist | 2922 Telestar Ct, Falls Church, VA 22042-1206 | 2010-05-05 |
| Find all providers in FALLS CHURCH | ||||
| City | FALLS CHURCH |
| Zip Code | 22046 |
Please comment or provide details below to improve the information on PRIVIA MEDICAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.