KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. (NPI# 1114565298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114565298 |
| Entity Type | Organization |
| Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. |
| Practice Address |
12255 Fair Lakes Pkwy Fairfax VA 22033-3952 |
| Practice Telephone | 7039345700 |
| Mailing Telephone | 7039345700 |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |
| Authorized Official Name | MR. JOSEPH T BUTZ (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 3018165867 |
| Is Organization Subpart | Y |
| Parent Organization Name | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Fair Oaks Medical Center DPP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316574833 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 4400 Forbes Blvd, Lanham, MD 20706-4447 | 2020-03-25 |
| 1215058326 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Health Maintenance Organization | 12255 Fair Oaks Pkwy, Fairfax, VA 22033-3952 | 2007-04-03 |
| 1285752121 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Health Maintenance Organization | 7670 Quarterfield Rd, Glen Burnie, MD 21061-3947 | 2007-03-27 |
| 1417075318 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Health Maintenance Organization | 7190 Crestwood Boulevard, Frederick, MD 21703-7314 | 2007-03-27 |
| 1699833202 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinical Medical Laboratory | 6625 Belcrest Highway, Hyattsville, MD 20782-2003 | 2006-12-05 |
| 1285272369 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 700 2nd St Ne, Washington, DC 20002-8100 | 2019-12-19 |
| 1457999542 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 4920 Campbell Blvd, Baltimore, MD 21236-5916 | 2019-12-19 |
| 1689212763 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 201 N Washington St, Falls Church, VA 22046-4518 | 2019-12-19 |
| 1659919744 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 6501 Loisdale Ct, Springfield, VA 22150-1826 | 2019-12-19 |
| 1710525803 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 14139 Potomac Mills Rd, Woodbridge, VA 22192-4644 | 2019-12-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 1 Kaiser Plz, Oakland, CA 94612-3610 |
| Street Address |
12255 FAIR LAKES PKWY |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22033-3952 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699776591 | Michael Scott Wenzel | Family Medicine | 12255 Fair Lakes Pkwy, Kaiser Permanente Fair Oaks Medical Center, Fairfax, VA 22033-3952 | 2005-08-02 |
| 1962027755 | Saly Damigou Moukdagou | Registered Nurse | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2020-06-08 |
| 1013367564 | Andaleeb Rahman | Family Medicine | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2016-06-15 |
| 1689062978 | Thuy-trinh Tran | Pharmacist | 12255 Fair Lakes Pkwy, Pharmacy Department, Fairfax, VA 22033-3952 | 2015-01-08 |
| 1871901645 | Anahita Aminshokravi | Optometrist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2014-07-24 |
| 1609209980 | Urvi P Shah | Physical Therapist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2013-08-09 |
| 1326381823 | Lujuana Faye Hairston | Pharmacist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2013-04-03 |
| 1679815708 | Peter Ho | Pharmacist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2013-03-27 |
| 1306188610 | Kimberly Marie Balaban | Pharmacist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2013-03-25 |
| 1235471756 | Abdullah Zhowandai | Pharmacist | 12255 Fair Lakes Pkwy, Fairfax, VA 22033-3952 | 2013-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366074320 | Han S Yoo | Pharmacist | 12200 West Ox Road, Fairfax, VA 22033 | 2020-02-07 |
| 1386137271 | Ammar Orthodontics Pllc | Dentist | 11702 Fiar Oaks Mall, Upper Floor, Fairfax, VA 22033 | 2018-06-14 |
| 1013360940 | Kellyn Patricia Dodd | Nurse Practitioner | 3903 Fair Ridge Dr Ste 209, Fairfax, VA 22033 | 2016-07-15 |
| 1659721363 | John Du Od PC | Optometrist | 12618 Victoria Station Ct, Fairfax, VA 22033 | 2016-06-14 |
| 1568861904 | Virginia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 12734 Shoppes Lane, Fairfax, VA 22033 | 2014-08-21 |
| 1649696295 | Patrisha Lultschik | Nurse Practitioner | 12375 Lee Jackson Memorial Hwy, Fairfax, VA 22033 | 2014-03-06 |
| 1912321910 | Alyson Huber | Nurse Anesthetist, Certified Registered | 3600 Joseph Siewick Dr., Fairfax, VA 22033 | 2014-02-11 |
| 1578999314 | Aiatulah Surmaty | Optometrist | 11801 Lee Jackson Memorial Hwy, Fairfax, VA 22033 | 2013-09-25 |
| 1356780928 | Ayatallah M. Khafagy | Obstetrics & Gynecology | 3650 Joseph Siewick Dr Suite 203, Fairfax, VA 22033 | 2013-06-17 |
| 1760726665 | Michelle Elise Schwartz | Speech-Language Pathologist | 3507 Curtice Farm Dr, Fairfax, VA 22033 | 2012-11-15 |
| Find all providers in zip 22033 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164080057 | Hao Health and Healing LLC | Clinic/Center | 12011 Lee Jackson Memorial Hwy Ste 320, Fairfax, VA 22033-3310 | 2019-06-05 |
| 1962946756 | Comprehensive Care Clinics | Clinic/Center | 3022 Williams Drive, Suite 100, Fairfax, VA 22031 | 2016-12-13 |
| 1245598085 | Medical Management of Virginia, LLC | Clinic/Center | 11230 Waples Mill Rd, Suite 125, Fairfax, VA 22030-6087 | 2012-04-30 |
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|---|---|---|---|---|
| 1205437167 | Asoufy Therapy Services, Pllc | Clinic/Center | 916 Saint Andrews Reach Apt A, Chesapeake, VA 23320-8587 | 2020-11-05 |
| 1710594932 | Healthy Advocate | Clinic/Center | 5904 Carrington Green Ct, Glen Allen, VA 23060-3439 | 2020-09-30 |
| 1518573864 | Yi's Acupuncture Clinic,inc. | Clinic/Center | 4216 Evergreen Ln Ste 112, Annandale, VA 22003-3253 | 2020-09-22 |
| 1770191660 | Treasure Health Inc | Clinic/Center | 6000 Stevenson Ave Ste F, Alexandria, VA 22304-3563 | 2020-07-17 |
| 1003443359 | Henry A Mccleary Dc LLC | Clinic/Center | 2239c Tacketts Mill Dr, Woodbridge, VA 22192-3026 | 2020-03-26 |
| 1962044420 | Alice Tseng Od Optometrist Pllc | Clinic/Center | 6211 Leesburg Pike, Falls Church, VA 22044-2107 | 2019-10-16 |
| 1245897941 | Metropolitan Medical | Clinic/Center | 3046 Valley Ave Ste 100, Winchester, VA 22601-2679 | 2019-05-29 |
| 1942768692 | Medsquare LLC | Clinic/Center | 8575a Sudley Rd, Manassas, VA 20110-3811 | 2019-03-12 |
| 1770055410 | Caring Hearts Free Clinic of Patrick County | Clinic/Center | 835 Woodland Dr Ste 101, Stuart, VA 24171-1586 | 2018-12-19 |
| 1851863708 | Tu Family Clinic LLC | Clinic/Center | 2946 Sleepy Hollow Rd Ste B, Falls Church, VA 22044-2003 | 2018-12-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.