REVERENT MEDICAL GROUP INC
NPI 1457861403
Internal Medicine in Fredericksburg, VA

Q: What is Reverent Medical Group Inc's NPI number?

The NPI number for Reverent Medical Group Inc is 1457861403. It was assigned to this organization in the NPPES registry on October 4, 2017.

Q: What is Reverent Medical Group Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since October 04, 2017CLIA 49D2182234 · Waiver

623 EMANCIPATION HWY STE 101, FREDERICKSBURG, VA 22401(800) 452-5574(540) 940-6249 Get Directions Write a Review

NPPES record last updated: October 12, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Oct 12, 2022, Mar 17, 2018 (2 updates tracked since 2018).

On this page

About Reverent Medical Group Inc NPPES

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

REVERENT MEDICAL GROUP INC (NPI 1457861403) is a healthcare organization registered as an internal medicine in Fredericksburg, Virginia and active in the NPI registry since October 2017. The organization holds a CLIA Waiver certificate valid through April 16, 2028, maintains 4 additional practice locations, and lists Petros Ayele, Co Owner, as its authorized official.

NPPES Registry Identity

NPI1457861403

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameREVERENT MEDICAL GROUP INC

Location Address623 EMANCIPATION HWY STE 101Fredericksburg, VA 22401-4437

Mailing Address623 Emancipation Hwy Ste 101Fredericksburg, VA 22401-4437 · (800) 452-5574 · Fax (540) 940-6249

Phone(800) 452-5574

Fax(540) 940-6249

Organization SubpartNo

Authorized OfficialPetros AyeleCo Owner · (202) 821-3040

Enumeration DateOctober 4, 2017

Last NPPES UpdateOctober 12, 20222 updates tracked since enumeration

NPPES CertifiedOctober 12, 2022

✔ NPI 1457861403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

623 EMANCIPATION HWY STE 101, Fredericksburg, VA 22401

Open in Google Maps ↗

Secondary Practice Locations 4

Location 18575 Rixlew LnManassas, VA 20109-3701 · Phone (202) 821-3040

Location 246531 Harry Byrd HwySterling, VA 20164-3555 · Phone (202) 821-3040

Location 350 S Pickett St Ste 221Alexandria, VA 22304-7206 · Phone (703) 823-4000

Location 417601 Harpers Ferry DrDumfries, VA 22025-2029 · Phone (202) 821-3040

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Reverent Medical Group Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 3 clinicians reassign Medicare billing to Reverent Medical Group Inc, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Rebecca Bulman

Nurse Practitioner

NPI 1487046702

4510 PLANK RD STE 200
Fredericksburg, VA 22407

(540) 785-9900

✔ PECOS3.0 mi

Petros Ayele, MD INTERNAL MED.

Internal Medicine

NPI 1720238868

2712 JEFFERSON DAVIS HIGHWAY SUITE 101
Stafford, VA 22554

(540) 657-9191

✔ PECOS✔ Accepts Medicare12 mi

Donna Cyrus, AGNP

Nurse Practitioner

NPI 1285004572

50 S PICKETT ST SUITE 221
Alexandria, VA 22304

(703) 823-4000

✔ PECOS41 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2182234

Reverent Medical Group, Inc · Fredericksburg, VA

Active · expires Apr 16, 2028

CLIA Number49D2182234

Laboratory TypePhysician Office

Certificate Effective DateApril 17, 2026

Certificate Expiration DateApril 16, 2028

Laboratory DirectorDonna F. Cyrus

Laboratory Phone(800) 452-5574

Laboratory LocationReverent Medical Group, Inc623 Jefferson Davis Highway, Suite 101, Fredericksburg, VA 22401

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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 Reverent Medical Group Inc's NPI number?

The NPI number for Reverent Medical Group Inc is 1457861403. It was assigned to this organization in the NPPES registry on October 4, 2017.

Where is Reverent Medical Group Inc located?

Reverent Medical Group Inc is located at 623 Emancipation Hwy Ste 101, Fredericksburg, VA 22401. The listed phone number is (800) 452-5574.

What is Reverent Medical Group Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Reverent Medical Group Inc enrolled in Medicare?

Yes. Reverent Medical Group Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Reverent Medical Group Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Reverent Medical Group Inc, in Internal Medicine and Nurse Practitioner. A 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 the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Reverent Medical Group Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2182234) is associated with this NPI, valid through April 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Reverent Medical Group Inc was last updated on October 12, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.