NPIMap

Organization Active NPI

Fairfax Family Practice Centers PC

Doing business as Broadlands Family Practice

  • Family Medicine Physician
  • Ashburn, VA
National Provider Identifier
1184748360
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAIRFAX FAMILY PRACTICE CENTERS PC
Doing business as
Broadlands Family Practice
Practice address
20905 Professional Plaza
Suite 330
Ashburn, VA 20147
Phone
(703) 726-0003
Fax
(703) 726-6444
NPI assigned
Mar 16, 2007
Last updated
Dec 27, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRFAX FAMILY PRACTICE CENTERS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

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

Authorized official

Name
James P Jenkins, MDNPI 1023002177
Title
President
Phone
(703) 255-9100

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

20905 Professional Plaza
Suite 330
Ashburn, VA 20147

Mailing address

PO Box 791128
Baltimore, MD 21279-1128
Phone (703) 726-0003

Other names 1

  • Broadlands Family Practice Doing business as

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
49D1018307Fairfax Family Practice Centers - Broadlands20905 Professional Plaza - Suite 330, Ashburn, VA 20147Provider-performed microscopyMar 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fairfax Family Practice10 organizations share this tax ID, including this one
Part of
Fairfax Family Practice

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1184748360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 791128",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212791128",
            "telephone_number": "703-726-0003",
            "fax_number": "703-726-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20905 PROFESSIONAL PLAZA",
            "address_2": "SUITE 330",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "20147",
            "telephone_number": "703-726-0003",
            "fax_number": "703-726-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX FAMILY PRACTICE CENTERS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRFAX FAMILY PRACTICE CENTERS PC",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-255-9100",
        "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": [
        {
            "organization_name": "Broadlands Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashburn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.