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DR. MARISSA MICHELLE MOULTRIE M.D.
NPI 1235591769
Family Medicine in Stafford, VA

Active since March 23, 2016PECOS EnrolledAccepts Medicare Assignment
125 HOSPITAL CENTER BLVD STE 110, STAFFORD, VA 22554(540) 602-6500 Get Directions Write a Review

NPPES record last updated: June 6, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 6, 2021, Mar 23, 2016 (2 updates tracked since 2016).

About Dr. Marissa Michelle Moultrie M.d. NPPES

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

DR. MARISSA MICHELLE MOULTRIE M.D. (NPI 1235591769) is an individual family medicine provider in Stafford, Virginia, licensed in Virginia (0101265808) and active in the NPI registry since March 2016. She is enrolled in Medicare PECOS, maintains a secondary practice location in Baltimore, and is a graduate of Medical University Of South Carolina College Of Medicine (2016).

NPPES Registry Identity

NPI1235591769
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameDR. MARISSA MICHELLE MOULTRIECredential: M.D.
Location Address125 HOSPITAL CENTER BLVD STE 110Stafford, VA 22554-6202
Mailing Address125 Hospital Center Blvd Ste 110Stafford, VA 22554-6202 · (540) 602-6500
Phone(540) 602-6500
Sole ProprietorNo
Medical School CMSMedical University Of South Carolina College Of MedicineGraduated 2016
Enumeration DateMarch 23, 2016
Last NPPES UpdateJune 6, 20212 updates tracked since enumeration
NPPES CertifiedJune 6, 2021
✔ NPI 1235591769 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0101265808
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
125 HOSPITAL CENTER BLVD STE 110, Stafford, VA 22554
Open in Google Maps ↗

Secondary Practice Location 1

Location 129 S Paca StBaltimore, MD 21201-1771 · Phone (667) 214-1880

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Marissa Michelle Moultrie M.d. 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 ID3971898651
PECOS Enrollment IDI20190828002779, I20210702002665
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.

Medicare Billing Reassignment

Medicare enrollment records show Marissa Moultrie reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc
18 mi
Health Maintenance Organization
13285 MINNIEVILLE ROAD
Woodbridge, VA 22192
  • Reassigned Medicare billing, Virginia and District of Columbia enrollments
  • Also billed through NPI 1215058326 (District of Columbia)
  • 995 clinicians in this Medicare group
NPI 1972275196 (301) 816-2424

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22554 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Health Maintenance Organization
125 HOSPITAL CENTER BLVD STE 110
STAFFORD, VA 22554
Stafford County (540) 602-6500
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Pharmacy (Managed Care Organization Pharmacy)
125 HOSPITAL CENTER BLVD STE 110
STAFFORD, VA 22554
Stafford County (540) 602-6300
RACHEL MARQUEZ MD
Family Medicine
125 HOSPITAL CENTER BLVD STE 110
STAFFORD, VA 22554
Stafford County (540) 602-6500
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Clinical Medical Laboratory
125 HOSPITAL CENTER BLVD STE 110
STAFFORD, VA 22554
Stafford County (540) 602-6500
NURU ABSENO ROBI M.D.
Obstetrics & Gynecology
125 HOSPITAL CENTER BLVD STE 110
STAFFORD, VA 22554
Stafford County (540) 602-6500

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 Marissa Moultrie's NPI number?

The NPI number for Marissa Moultrie is 1235591769. It was assigned to this individual provider in the NPPES registry on March 23, 2016.

Where is Marissa Moultrie located?

Marissa Moultrie practices at 125 Hospital Center Blvd Ste 110, Stafford, VA 22554. The listed phone number is (540) 602-6500.

What is Marissa Moultrie's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Marissa Moultrie enrolled in Medicare?

Yes. Marissa Moultrie 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.

Which organization bills Medicare for Marissa Moultrie's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Marissa Moultrie reassigns Medicare benefits to Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc (Woodbridge, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Marissa Moultrie's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Marissa Moultrie was last updated on June 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.