NPIMap

Organization Active NPI

Neighborhood Health

Doing business as Neighborhood Health at Merrifield Center

  • Federally Qualified Health Center (FQHC)
  • Fairfax, VA
National Provider Identifier
1154988269
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTH
Doing business as
Neighborhood Health at Merrifield Center
Practice address
8221 Willow Oaks Corporate Dr Ste 450
Fairfax, VA 22031-4512
Phone
(703) 535-5568
NPI assigned
May 23, 2019
Last updated
May 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

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

Authorized official

Name
Basim Khan, MDNPI 1477880045
Title
Executive Director
Phone
(703) 778-0639

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

8221 Willow Oaks Corporate Dr Ste 450
Fairfax, VA 22031-4512

Mailing address

6677 Richmond Hwy FL 4
Alexandria, VA 22306-6647
Phone (703) 778-0639

Other names 1

  • Neighborhood Health at Merrifield Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040707000325 DC Part B Supplier - Clinic/Group Practice 7517853419 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, VA; Annandale, VA; Alexandria, VA
O20190802001245 VA Part A Provider - Federally Qualified Health Center (FQHC) 7517853419 Practice locations: Fairfax, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154988269. Details of each certification follow.

Federally qualified health center certification: CCN 491970

Legal name
NEIGHBORHOOD HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 6, 2019
Last certification
Jun 6, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1997 in VA
Enrollment address
8221 Willow Oaks Corporate Dr
Ste 450
Fairfax, VA 22031-4512

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

Locations

6677 Richmond Hwy
Fl 4
Alexandria, VA 22306

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alisa Whyte Individual Corporate DirectorTreasurer Nov 1, 2014
Miriam Aguila Individual Corporate Director Oct 18, 2015
Basim N Khan Individual Corporate DirectorExecutive Director Sep 17, 2014
W-2 Managing Employee Jul 1, 2019
Operational/Managerial Control Sep 17, 2014
Michael Millman Individual Corporate DirectorVP Mar 30, 2015
Carter Flemming Individual Corporate DirectorMember Aug 18, 2014
Thomas W Greeson Individual Corporate DirectorBoard President Sep 1, 2011
Muhammad Arif Individual Corporate DirectorMember Jan 1, 2019
Richard Gundling Individual Corporate Director Nov 1, 2014
Elhafedh Talebimijine Individual Corporate DirectorMember Mar 1, 2019
Paola Navarro Individual Corporate Director Oct 5, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1154988269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 RICHMOND HWY FL 4",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223066647",
            "telephone_number": "703-778-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR STE 450",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-535-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "BASIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "703-778-0639",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neighborhood Health at Merrifield Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.