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MR. MARK EMANUEL VASILIADIS M.D.
NPI 1639241771
Family Medicine in Reston, VA

Active since November 14, 2006Opted out of Medicare · through Jan 1, 2027
12040 S LAKES DR, SUITE 195, RESTON, VA 20191(703) 230-0347 Get Directions Write a Review

NPPES record last updated: August 25, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Mark Emanuel Vasiliadis M.d. NPPES

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

MR. MARK EMANUEL VASILIADIS M.D. (NPI 1639241771) is an individual family medicine provider in Reston, Virginia, licensed in Virginia (0101050406) and active in the NPI registry since November 2006. He has opted out of Medicare through January 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1639241771
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameMR. MARK EMANUEL VASILIADISCredential: M.D.
Location Address12040 S LAKES DR, SUITE 195Reston, VA 20191-1246
Mailing Address12040 S Lakes Dr Ste 204Reston, VA 20191-1236 · (703) 230-0347 · Fax (703) 230-0350
Phone(703) 230-0347
Sole ProprietorNo
Enumeration DateNovember 14, 2006
Last NPPES UpdateAugust 25, 2022
NPPES CertifiedAugust 25, 2022
✔ NPI 1639241771 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0101050406
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.
12040 S LAKES DR, Reston, VA 20191
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Other Identifiers 1

Other593776473VA · Tax Id

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mr. Mark Emanuel Vasiliadis M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2013 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2013
Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20191 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
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
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 12

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

GENERATIONS FAMILY MEDICINE PC
Family Medicine
12040 S LAKES DR, STE 190
RESTON, VA 20191
Fairfax County (703) 464-0686
DR. JOHN P MAMANA M.D.
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
EHS CORPORATE CARE
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
DR. KEVIN J KELLEHER MD
Family Medicine
12040 S LAKES DR, STE 207
RESTON, VA 20191
Fairfax County (703) 464-0686
EXECUTIVE HEALTHCARE SERVICES PLLC
Family Medicine
12040 S LAKES DR, SUITE 195
RESTON, VA 20191
Fairfax County (703) 230-0347
LAURA LISBETH KENNEDY RN, FNP-BC
Nurse Practitioner (Family)
12040 S LAKES DR
RESTON, VA 20191
Fairfax County (703) 464-0686
DEANNA LYNN MARKLEY PA
Physician Assistant (Medical)
12040 S LAKES DR, SUITE 207
RESTON, VA 20191
Fairfax County (703) 464-0686
ARAMESH DARVISHIAN DDS
Dentist
12040 S LAKES DR, SUITE 200
RESTON, VA 20191
Fairfax County (703) 955-4440

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 Mark Vasiliadis's NPI number?

The NPI number for Mark Vasiliadis is 1639241771. It was assigned to this individual provider in the NPPES registry on November 14, 2006.

Where is Mark Vasiliadis located?

Mark Vasiliadis practices at 12040 S Lakes Dr Suite 195, Reston, VA 20191. The listed phone number is (703) 230-0347.

What is Mark Vasiliadis's specialty?

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

Is Mark Vasiliadis enrolled in Medicare?

No. Mark Vasiliadis has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mark Vasiliadis was last updated on August 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.