Individual provider Active NPI

Randala R Lakkis, M.D.

  • Pediatric Nephrology Physician
  • Fairfax, VA
National Provider Identifier
1235226663
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
0101238274 Issued in VA
Practice address
3023 Hamaker CT Ste 600
Fairfax, VA 22031-2241
Phone
(703) 876-2788
Fax
(703) 839-8763
NPI assigned
Oct 6, 2006
Last updated
Nov 27, 2023By the provider in NPPES
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
Pediatric Nephrology Physician 2080P0210X 0101238274 VA Primary

Addresses

Primary practice location

3023 Hamaker CT Ste 600
Fairfax, VA 22031-2241

Mailing address

3023 Hamaker CT Ste 600
Fairfax, VA 22031-2241
Phone (703) 876-2788

Other practice location 1

1250 E Marshall St
Pediatrics
Richmond, VA 23298-5051
Phone (804) 628-7337

Other identifiers 1

IdentifierTypeStateIssuer
277144600MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rlakkis99064@soc.inova.org Health Information Exchange (HIE) Pediatric Specialists of Virginia, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120203000403 VA Practitioner - Pediatric MedicinePractitioner - Nephrology 8527225499 Reassigns benefits to 2 organizations
I20130802000581 DC Practitioner - Pediatric Medicine 8527225499 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Nephrology
Education
University of Miami, LM Miller School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

3300 Gallows Rd
Falls Church, VA 22042-3307

Merit-based Incentive Payment System (MIPS)

Final score
83.36 of 100Reported as group
Quality
73.03
Promoting interoperability
100
Improvement activities
40
Cost
71.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince May 3, 2025 Accepting new patients
Medstar Medical Group II LLC CurrentSince Feb 26, 2014 Accepting new patients
Pediatric Specialists of Virginia, LLC CurrentSince Feb 17, 2014 Accepting new patients
Inova Health Care Services CurrentSince Jul 15, 2013 Accepting new patients
MGMC, LLC CurrentSince Feb 26, 2014 Accepting new patients
Inova Health Care Services Pediatric Nephrology CurrentSince Jul 15, 2013 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
MCV Associated Physicians PastSince Sep 28, 2021 Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

3023 Hamaker Ct
Ste 400
Fairfax, VA 22031
Phone (571) 226-8380

3023 Hamaker Ct
Ste 600
Fairfax, VA 22031
Phone (703) 876-2778

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

14904 Richmond Hwy
Woodbridge, VA 22191
Phone (703) 897-7463

Interoperability endpoints

  • Direct secure messaging: rlakkis99064@soc.inova.org

Organizations & group practices 8

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1235226663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3023 HAMAKER CT STE 600",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312241",
            "telephone_number": "703-876-2788",
            "fax_number": "703-839-8763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 HAMAKER CT STE 600",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312241",
            "telephone_number": "703-876-2788",
            "fax_number": "703-839-8763"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Marshall St",
            "address_2": "Pediatrics",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985051",
            "country_code": "US",
            "telephone_number": "804-628-7337",
            "fax_number": "804-827-1771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKKIS",
        "first_name": "RANDALA",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "VA",
            "license": "0101238274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277144600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rlakkis99064@soc.inova.org",
            "affiliation": "Y",
            "endpointDescription": "Health Information Exchange",
            "affiliationName": "Pediatric Specialists of Virginia, LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3023 Hamaker Ct Ste 600",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220312241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.