PRIMARY GERONTOLOGY CENTER LLC (NPI# 1215425384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215425384 |
| Entity Type | Organization |
| Organization Name | PRIMARY GERONTOLOGY CENTER LLC |
| Practice Address |
4196 Merchant Plz Ste 348 Lake Ridge VA 22192-5085 |
| Mailing Address |
4216 Evergreen Ln Ste 121 Annandale VA 22003-3256 |
| Practice Telephone | 5712061650 |
| Mailing Telephone | 5712061650 |
| Mailing Fax Number | 7036626165 |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2020-07-01 |
| Authorized Official Name | JIHO CHOI (OWNER/STAFF PHYSICIAN) |
| Authorized Official Telephone | 5712061650 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
VA | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | primary gerontology center LLC | 4196 Merchant Plaza Ste 348, Lake Ridge, Virginia 22192-5085 |
| Street Address |
4196 MERCHANT PLZ STE 348 |
| City | LAKE RIDGE |
| State | VA |
| Zip Code | 22192-5085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245873645 | Ursula Jackson | Technician | 3500 Commission Ct, Woodbridge, VA 22192 | 2019-10-18 |
| 1205480779 | Ki Soo Park | Physical Therapy Assistant | 12825 Minnieville Road Suite 201, Lake Ridge, VA 22192 | 2019-08-01 |
| 1801448329 | Karen Lee Trivett | Specialist/Technologist, Other | 12584 Darby Brook Court, Woodbridge, VA 22192 | 2019-07-15 |
| 1407313166 | Nichele Amelia Thompson | Behavioral Analyst | 2731 Marblestone Dr, 101, Woodbridge, VA 22192 | 2019-02-28 |
| 1952877870 | Kimberly Ann Rojas Vazquez | Behavioral Analyst | 12531 Clipper Dr, Suite 203, Woodbridge, VA 22192 | 2018-10-18 |
| 1104391614 | Ykim Dental | Dentist | 2680 Optiz Blvd., Suite 120, Woodbridge, VA 22192 | 2018-10-11 |
| 1013418755 | Arm Transport | Non-emergency Medical Transport (VAN) | 13000 Harbor Center Dr Ste 132d, Woodbridge, VA 22192 | 2018-02-27 |
| 1811496813 | Francesca Nasi | Behavioral Analyst | 12531 Clipper Dr Ste 203, Woodbridge, VA 22192 | 2018-02-05 |
| 1942729504 | Bismark Transportation Service LLC | Non-emergency Medical Transport (VAN) | 12341 Woodlawn Court, Woodbridge, VA 22192 | 2017-09-14 |
| 1992226344 | Arm Baby Eldery Home Health LLC | Home Health | 13000 Harbor Center Dr # 312c, Woodbridge, VA 22192 | 2017-07-06 |
| Find all providers in zip 22192 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932694015 | Gibbs Mobile Med, LLC | Family Medicine | 4115 Annandale Rd Ste 203, Annandale, VA 22003-2500 | 2018-06-29 |
| 1760994073 | Mk Cognition, Inc | Family Medicine | 807 Cameron St, Alexandria, VA 22314-2409 | 2017-10-26 |
| 1831639111 | Ad Senior Medical LLC | Family Medicine | 5000 Stoneleigh Rd, Henrico, VA 23228-5927 | 2017-03-06 |
| 1992162267 | Virginia Nursing Homes Specialists Pllc | Family Medicine | 41544 Hoddesdon Ct, Aldie, VA 20105-3097 | 2016-01-18 |
| 1881060028 | Dante Jocson | Family Medicine | 9120 Park Ave, Manassas, VA 20110-4351 | 2015-08-11 |
| 1639563414 | Promedical Services, Inc. | Family Medicine | 30 Monica Blvd, Lynchburg, VA 24502-2269 | 2015-03-19 |
| 1205258829 | Roanoke Adult Medicine LLC | Family Medicine | 1708 Clay St Se, Roanoke, VA 24013-2105 | 2014-01-16 |
| 1336470988 | Ruth Arnetta Jones | Family Medicine | 7515 Chamberlayne Ave., Henrico, VA 23227 | 2010-01-21 |
| 1235313933 | Michael C. Trahos, D.o. | Family Medicine | 6613 Goldsboro Rd, Falls Church, VA 22042-4108 | 2007-12-18 |
| 1477763746 | John R Patterson Md PC | Family Medicine | 2145 Old Pungo Ferry Rd, Virginia Beach, VA 23457-1341 | 2007-05-23 |
| Find all providers with the same taxonomy | ||||
| City | LAKE RIDGE |
| Zip Code | 22192 |
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| 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.