NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

Doing business as Fair Oaks Medical Center

  • Health Maintenance Organization
  • Fairfax, VA
National Provider Identifier
1215058326
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Doing business as
Fair Oaks Medical Center
Practice address
12255 Fair Oaks Pkwy
Fairfax, VA 22033-3952
Phone
(703) 934-5700
Fax
(703) 934-5745
NPI assigned
Apr 3, 2007
Last updated
Jul 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Authorized official

Name
Colleen Swinton
Title
Director, Credentialing
Phone
(301) 257-2797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

12255 Fair Oaks Pkwy
Fairfax, VA 22033-3952

Mailing address

4000 Garden City Dr
Hyattsville, MD 20785-2418
Phone (301) 816-2424

Other names 1

  • Fair Oaks Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000308 DC Part B Supplier - Clinic/Group Practice 3779495858 Receives reassigned benefits from 2,537 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lanham, MD; Largo, MD; MC Lean, VA; Reston, VA; Rockville, MD; Silver Spring, MD; Fairfax, VA; Springfield, VA…

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Found HLTH Plan169 organizations share this tax ID, including this one
Part of
Kaiser Found HLTH Plan

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1215058326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 GARDEN CITY DR",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207852418",
            "telephone_number": "301-816-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 FAIR OAKS PKWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333952",
            "telephone_number": "703-934-5700",
            "fax_number": "703-934-5745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
        "enumeration_date": "2007-04-03",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "SWINTON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING",
        "authorized_official_telephone_number": "301-257-2797"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6104 Old Branch Ave",
            "city": "Temple Hills",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207482518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Fair Oaks Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fair Oaks Medical Center",
            "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 Jul 24, 2025; 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.