NPIMap

Organization Active NPI

Barry B Ekdom PHD, PC

Doing business as Ekdom Neuropsychology Group

  • Clinical Neuropsychologist
  • Fairfax, VA
National Provider Identifier
1194804914
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
081001775 Issued in VA
Legal business name
BARRY B EKDOM PHD, PC
Doing business as
Ekdom Neuropsychology Group
Practice address
3040 Williams Dr
Suite 402
Fairfax, VA 22031-4618
Phone
(703) 573-3575
Fax
(703) 573-3574
NPI assigned
Nov 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Dr. Nicole Hashemian, PSYDNPI 1861008492
Title
Owner
Phone
(703) 573-3573

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
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 081001775 VA Primary

Addresses

Primary practice location

3040 Williams Dr
Suite 402
Fairfax, VA 22031-4618

Mailing address

3040 Williams Dr
Suite 402
Fairfax, VA 22031-4618
Phone (703) 573-3575

Other names 1

  • Ekdom Neuropsychology Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160301001147 DC Part B Supplier - Clinic/Group Practice 6901101807 Receives reassigned benefits from 3 practitioners
Practice locations: Fairfax, VA

National Provider Directory

National Provider Directory

Locations

3040 Williams Dr
Ste 402
Fairfax, VA 22031
Phone (703) 573-3573

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1194804914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR",
            "address_2": "SUITE 402",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314618",
            "telephone_number": "703-573-3575",
            "fax_number": "703-573-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR",
            "address_2": "SUITE 402",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314618",
            "telephone_number": "703-573-3575",
            "fax_number": "703-573-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY B EKDOM PHD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "HASHEMIAN",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-573-3573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "VA",
            "license": "081001775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ekdom Neuropsychology Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.