Inova Oakville Ambulatory Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

INOVA OAKVILLE AMBULATORY SURGERY CENTER, LLC

Practice address

400 Fannon St Ste 200
Alexandria, VA 22301

Phone

(703) 672-2635

Fax

(703) 672-2650

NPI assigned

Feb 2, 2024

Last updated

Sep 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darasinh Phoummithone Mayard

Title

A/R & Operations Manager

Phone

(703) 395-6410

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255194189. Details of each certification follow.

• CCN 49C0001112 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 49C0001112

Legal name

Inova Oakville Ambulatory Surgery Center, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 24, 2025

Last certification

Apr 16, 2025

Ownership / control type

Proprietary

Facility address

400 Fannon Street, Suite 200
Alexandria, VA 22301

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://f6cd4dc2-092b-4744-b0da-c39d755e6426.gastro.prod.fhir.ema-api.com/fhir/r4/

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1255194189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FANNON ST.",
            "address_2": "200",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "22301",
            "telephone_number": "703-672-2624",
            "fax_number": "703-672-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FANNON ST STE 200",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "22301",
            "telephone_number": "703-672-2635",
            "fax_number": "703-672-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INOVA OAKVILLE AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-02",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "MAYARD",
        "authorized_official_first_name": "DARASINH",
        "authorized_official_middle_name": "PHOUMMITHONE",
        "authorized_official_title_or_position": "A/R & OPERATIONS MANAGER",
        "authorized_official_telephone_number": "703-395-6410"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Ambulatory Surgical Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.