1. Home
  2. Directory
  3. Virginia
  4. Harrisonburg
  5. Family Medicine
  6. NPI Profile

ERICA LAUREN FORMATO MD
NPI 1699161679
Family Medicine in Harrisonburg, VA

Active since April 07, 2015PECOS EnrolledAccepts Medicare Assignment
95.11/100
CMS Quality Rating
1790 E MARKET ST STE 64B, HARRISONBURG, VA 22801(540) 564-5666(844) 501-7984 Get Directions Write a Review

NPPES record last updated: October 10, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 10, 2024, Jul 21, 2022, Jul 12, 2019 and 2 more (5 updates tracked since 2016).

About Erica Lauren Formato Md NPPES

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

ERICA LAUREN FORMATO MD (NPI 1699161679) is an individual family medicine provider in Harrisonburg, Virginia, licensed in Virginia (0101264179) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS, is affiliated with Sentara Rmh Medical Center, and is a graduate of Eastern Virginia Medical School (2015).

NPPES Registry Identity

NPI1699161679
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameERICA LAUREN FORMATOCredential: MD
Location Address1790 E MARKET ST STE 64BHarrisonburg, VA 22801-5197
Mailing Address1790 E Market St Ste 64bHarrisonburg, VA 22801-5197 · (540) 564-5666 · Fax (844) 501-7984
Phone(540) 564-5666
Fax(844) 501-7984
Sole ProprietorYes
Medical School CMSEastern Virginia Medical SchoolGraduated 2015
Enumeration DateApril 7, 2015
Last NPPES UpdateOctober 10, 20245 updates tracked since enumeration
NPPES CertifiedOctober 10, 2024
✔ NPI 1699161679 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 · 0101264179
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
1790 E MARKET ST STE 64B, Harrisonburg, VA 22801
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

Erica Lauren Formato Md 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 ID6305146747
PECOS Enrollment IDI20180725002723
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 7

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 moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
232 services113 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
166 services104 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
92 services92 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
43 services43 patients
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.
41 services31 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
20 services20 patients

Hospital Affiliations CMS Care Compare 3

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

Sentara Rmh Medical Center

Acute Care Hospitals · Harrisonburg, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490004
Location2010 Health Campus DriveHarrisonburg, VA 22801 · Harrisonburg City County
Emergency services Birthing friendly

Augusta Health

Acute Care Hospitals · Fishersville, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490018
Location78 Medical Center DriveFishersville, VA 22939 · Augusta County
Emergency services Birthing friendly

Sentara Martha Jefferson Hospital

Acute Care Hospitals · Charlottesville, VA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490077
Location500 Martha Jefferson DriveCharlottesville, VA 22911 · Albemarle County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22801 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.11/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality86.31
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
10 suppliers23 claims54 services$6.66 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers11 claims18 services$1.06 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
4 suppliers27 claims27 services$190.61 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 10

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

GILBERT C RICE III DO
Family Medicine
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666
PAMELA DORONDA BAILEY PA-C
Physician Assistant (Medical)
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5622
MELISSA KATHERINE KOLLMAN P.A.
Physician Assistant
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666
LIDIYA GUTNIKOVA MD
Internal Medicine
1790 E MARKET ST STE 64B
ROCKINGHAM, VA 22801
Harrisonburg City (540) 564-5666
TRENT MAZER MD
Internal Medicine
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666
CHARITY B TRISSEL FNP-BC
Nurse Practitioner (Family)
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666
BRYCE COOLIDGE SIMES DO
Internal Medicine
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666
BROOKE ELIZABETH ASHLEY NP
Nurse Practitioner (Acute Care)
1790 E MARKET ST STE 64B
HARRISONBURG, VA 22801
Harrisonburg City (540) 564-5666

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 Erica Formato's NPI number?

The NPI number for Erica Formato is 1699161679. It was assigned to this individual provider in the NPPES registry on April 7, 2015.

Where is Erica Formato located?

Erica Formato practices at 1790 E Market St Ste 64B, Harrisonburg, VA 22801. The listed phone number is (540) 564-5666.

What is Erica Formato's specialty?

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

Is Erica Formato enrolled in Medicare?

Yes. Erica Formato 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 Erica Formato affiliated with any hospitals?

According to CMS data, Erica Formato is affiliated with Sentara Rmh Medical Center, Augusta Health and Sentara Martha Jefferson Hospital.

When was this NPI record last updated?

The NPPES record for Erica Formato was last updated on October 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.