1. Home
  2. Directory
  3. Virginia
  4. Reston
  5. Physician Assistant
  6. NPI Profile

LARRY C MACK-WILSON P.A.
NPI 1235413667
Physician Assistant - Medical in Reston, VA

Active since October 04, 2011PECOS EnrolledAccepts Medicare Assignment
1850 TOWN CENTER PKWY, RESTON, VA 20190(703) 689-9039(703) 689-9109 Get Directions Write a Review

NPPES record last updated: October 4, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Larry C Mack-wilson P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LARRY C MACK-WILSON P.A. (NPI 1235413667) is an individual medical provider in Reston, Virginia, licensed in Virginia (0110003693) and active in the NPI registry since October 2011. He is enrolled in Medicare PECOS, is affiliated with Virginia Hospital Center, and is a graduate of Other (2011).

NPPES Registry Identity

NPI1235413667
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameLARRY C MACK-WILSONCredential: P.A.
Location Address1850 TOWN CENTER PKWYReston, VA 20190-3219
Mailing Address20010 Century Blvd, Suite 200Germantown, MD 20874-1115 · (240) 686-2300 · Fax (240) 686-2330
Phone(703) 689-9039
Fax(703) 689-9109
Sole ProprietorNo
Medical School CMSOtherGraduated 2011
Enumeration DateOctober 4, 2011
✔ NPI 1235413667 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in VA · 0110003693
1850 TOWN CENTER PKWY, Reston, VA 20190
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Larry C Mack-wilson P.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9234303876
PECOS Enrollment IDI20111117000289
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
35 services34 patients
Urinalysis, manual test 81002
A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.
11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Virginia Hospital Center

Acute Care Hospitals · Arlington, VA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490050
Location1701 North George Mason DriveArlington, VA 22205 · Arlington County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEDSTAR MEDICAL GROUP II LLC
General Practice
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (202) 877-7685
DR. DAVID E KARDON MD
Pathology (Anatomic Pathology & Clinical Pathology)
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (703) 689-9093
DR. ANDREW HARRIS GORDON M.D., PH.D.
Physical Medicine & Rehabilitation
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (703) 949-9660
BERNARD JAMES GAMIAO
Occupational Therapist
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (703) 689-9000
SEON H LEE MD
Emergency Medicine
1850 TOWN CENTER PKWY, RESTON HOSPITAL CENTER
RESTON, VA 20190
Fairfax County (703) 689-9037
MRS. DIANE D ZHAO MD
Physical Medicine & Rehabilitation
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (703) 689-9000
DR. JAMES L TORRENS MD
Anesthesiology
1850 TOWN CENTER PKWY, RESTON HOSPITAL CENTER
RESTON, VA 20190
Fairfax County (703) 471-0919
JOHN M YOUNG CRNA
Nurse Anesthetist, Certified Registered
1850 TOWN CENTER PKWY
RESTON, VA 20190
Fairfax County (703) 471-0919

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Larry Mack-wilson's NPI number?

The NPI number for Larry Mack-wilson is 1235413667. It was assigned to this individual provider in the NPPES registry on October 4, 2011.

Where is Larry Mack-wilson located?

Larry Mack-wilson practices at 1850 Town Center Pkwy, Reston, VA 20190. The listed phone number is (703) 689-9039.

What is Larry Mack-wilson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Larry Mack-wilson enrolled in Medicare?

Yes. Larry Mack-wilson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Larry Mack-wilson affiliated with any hospitals?

According to CMS data, Larry Mack-wilson is affiliated with Virginia Hospital Center.

When was this NPI record last updated?

The NPPES record for Larry Mack-wilson was last updated on October 4, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.