Organization Active NPI

Family Healthcare of Fairfax PC

  • Family Medicine Physician
  • Fairfax, VA
National Provider Identifier
1144357633
Registry record updated Dec 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY HEALTHCARE OF FAIRFAX PC
Practice address
3025 Hamaker CT Ste 350
Fairfax, VA 22031-2243
Phone
(703) 573-6400
Fax
(703) 641-5821
NPI assigned
Feb 28, 2007
Last updated
Dec 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eugene A Shmorhun, MDNPI 1255468526
Title
Owner
Phone
(703) 573-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3025 Hamaker CT Ste 350
Fairfax, VA 22031-2243

Mailing address

3025 Hamaker CT Ste 350
Fairfax, VA 22031-2243
Phone (703) 573-6400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110627000234 DC Part B Supplier - Clinic/Group Practice 8921286717 Receives reassigned benefits from 3 practitioners
Practice locations: Fairfax, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0867427Family Healthcare of Fairfax, PC3025 Hamaker Court #350, Fairfax, VA 22031Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory

Locations

3025 Hamaker Ct
Ste 350
Fairfax, VA 22031
Phone (703) 573-6400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1144357633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 HAMAKER CT STE 350",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312243",
            "telephone_number": "703-573-6400",
            "fax_number": "703-641-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 HAMAKER CT STE 350",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312243",
            "telephone_number": "703-573-6400",
            "fax_number": "703-641-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTHCARE OF FAIRFAX PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "SHMORHUN",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-573-6400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.