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PRIME CARE FAMILY PRACTICE, P.C.
NPI 1881629384
Family Medicine in Prince George, VA

Active since July 12, 2006CLIA 49D2096506 · Waiver
4700 PUDDLEDOCK ROAD, SUITE 300, PRINCE GEORGE, VA 23875(804) 526-1111(804) 526-8363 Get Directions Write a Review

NPPES record last updated: March 3, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Prime Care Family Practice, P.c. NPPES

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

PRIME CARE FAMILY PRACTICE, P.C. (NPI 1881629384) is a healthcare organization registered as a family medicine in Prince George, Virginia and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through May 26, 2027 and lists Deidra F. Mann, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1881629384
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePRIME CARE FAMILY PRACTICE, P.C.
Location Address4700 PUDDLEDOCK ROAD, SUITE 300Prince George, VA 23875-1268
Mailing Address4700 Puddledock Road, Suite 300Prince George, VA 23875-1268 · (804) 526-1111 · Fax (804) 526-8363
Phone(804) 526-1111
Fax(804) 526-8363
Organization SubpartNo
Authorized OfficialDeidra F. MannPractice Manager · (804) 526-1111
Enumeration DateJuly 12, 2006
Last NPPES UpdateMarch 3, 2025
NPPES CertifiedMarch 3, 2025
✔ NPI 1881629384 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.
4700 PUDDLEDOCK ROAD, Prince George, VA 23875
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE 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)

Prime Care Family Practice, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Prime Care Family Practice, P.C., which bills Medicare for the services they deliver. Of these, 7 practice at this address. They are listed nearest first.

Clinicians, nearest first (7)

Tanesha Ford, FNP
Nurse Practitioner
NPI 1063290534
4700 PUDDLEDOCK RD STE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Matthew Marchal, M.D.
Family Practice
NPI 1457318503
4700 PUDDLEDOCK RD STE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Karen Richmond, FNP-C
Nurse Practitioner
NPI 1144017898
4700 PUDDLEDOCK RD STE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Lisa Shah, D.O.
Family Practice
NPI 1316129893
4700 PUDDLEDOCK RD SUITE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Lesli Brown, M.D.
Family Practice
NPI 1073749461
4700 PUDDLEDOCK RD SUITE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Christopher Ogburn, MD
Family Practice
NPI 1023037165
4700 PUDDLEDOCK RD SUITE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address
Tami Rickey, NP
Nurse Practitioner
NPI 1760403141
4700 PUDDLEDOCK ROAD SUITE 300
Prince George, VA 23875
(804) 526-1111
✔ PECOS✔ Accepts MedicareSame address

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 49D2096506

Prime Care Family Practice · Prince George, VA
Active · expires May 26, 2027
CLIA Number49D2096506
Laboratory TypePhysician Office
Certificate Effective DateMay 27, 2025
Certificate Expiration DateMay 26, 2027
Laboratory DirectorLisa C. Shah
Laboratory Phone(804) 526-1111
Laboratory LocationPrime Care Family Practice4700 Puddledock Road - Suite 300, Prince George, VA 23875
CLIA data matches this NPI record on: Address 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 Prime Care Family Practice, P.C.'s NPI number?

The NPI number for Prime Care Family Practice, P.C. is 1881629384. It was assigned to this organization in the NPPES registry on July 12, 2006.

Where is Prime Care Family Practice, P.C. located?

Prime Care Family Practice, P.C. is located at 4700 Puddledock Road Suite 300, Prince George, VA 23875. The listed phone number is (804) 526-1111.

What is Prime Care Family Practice, P.C.'s specialty?

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

Is Prime Care Family Practice, P.C. enrolled in Medicare?

Yes. Prime Care Family Practice, P.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prime Care Family Practice, P.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Prime Care Family Practice, P.C.. 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. The largest specialties are Family Practice (4) and Nurse Practitioner (3). Of these, 7 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Prime Care Family Practice, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2096506) is associated with this NPI, valid through May 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prime Care Family Practice, P.C. was last updated on March 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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.