Individual provider Active NPI

Suzan Elizabeth Shibla, CFNP

  • Family Nurse Practitioner
  • Fairfax, VA
National Provider Identifier
1174519227
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024164504 Issued in VA
Practice address
3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710
Phone
(703) 391-2020
Fax
(703) 391-1211
NPI assigned
Sep 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024164504 VA Primary

Addresses

Primary practice location

3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710

Mailing address

3650 Joseph Siewick Dr
Suite 400
Fairfax, VA 22033-1710
Phone (703) 391-2020

Other names 1

  • Suzan Elizabeth Walsh Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sshibla708251@soc.inova.org Health Information Exchange (HIE) Inova Physician Partners, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000888 DC Practitioner - Nurse Practitioner 1052378916 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Physician Partners LLCGroup PAC ID 2466581772, 258 clinicians

Practice addresses (Care Compare)

3650 Joseph Siewick Dr
Suite 101
Fairfax, VA 22033-1700
Phone (703) 391-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024164504VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Jul 13, 2015 Accepting new patients
Inova Physician Partners, LLC CurrentSince Jun 25, 2020 Accepting new patients
Privia Medical Group, LLC CurrentSince Jul 13, 2015 Accepting new patients
Inova Physician Partners, Inc. - Specialists Past Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

3914 Centreville Rd
Ste 250
Chantilly, VA 20151
Phone (703) 435-1223

3650 Joseph Siewick Dr
Ste 400
Fairfax, VA 22033
Phone (703) 391-2020

8095 Innovation Park Dr
Bldg C
Fairfax, VA 22031
Phone (571) 472-6253

3650 Joseph Siewick Dr
Ste 101
Fairfax, VA 22033
Phone (703) 391-0900

Interoperability endpoints

  • Direct secure messaging: sshibla708251@soc.inova.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1174519227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020",
            "fax_number": "703-391-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 JOSEPH SIEWICK DR",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331710",
            "telephone_number": "703-391-2020",
            "fax_number": "703-391-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIBLA",
        "first_name": "SUZAN",
        "middle_name": "ELIZABETH",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024164504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshibla708251@soc.inova.org",
            "affiliation": "Y",
            "endpointDescription": "Health Information Exchange",
            "affiliationName": "Inova Physician Partners, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3650 Joseph Siewick Dr",
            "address_2": "Suite 400",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220331710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUZAN",
            "last_name": "WALSH",
            "middle_name": "ELIZABETH",
            "credential": "CFNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.