Individual provider Active NPI

Lishan Kassa, MD

  • Internal Medicine Physician
  • Chantilly, VA
National Provider Identifier
1255534301
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101058868 Issued in VA
Practice address
4213 Walney Rd
Chantilly, VA 20151-2923
Phone
(703) 502-7000
NPI assigned
Jun 7, 2007
Last updated
Dec 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101058868 VA Primary

Addresses

Primary practice location

4213 Walney Rd
Chantilly, VA 20151-2923

Mailing address

4213 Walney Rd
Chantilly, VA 20151-2923
Phone (703) 502-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20231221003483 DC Practitioner - Internal Medicine 4284084856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4213 Walney Rd
Fairfax Falls Church Community Services Boa
Chantilly, VA 20151-2923
Phone (703) 324-7000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101058868VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax County, Virginia CurrentSince Nov 27, 2023 Accepting new patients
Fairfax Falls Church Community Service Board PastSince Nov 27, 2023 Accepting new patients

Locations

4213 Walney Rd
Chantilly, VA 20151
Phone (703) 502-7000

12011 Government Center Pkwy
Ste 836
Fairfax, VA 22035
Phone (703) 324-3360

10520 Judicial Dr
Fairfax, VA 22030
Phone (703) 246-2100

Organizations & group practices 2

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": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1255534301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 WALNEY RD",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512923",
            "telephone_number": "703-502-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4213 WALNEY RD",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512923",
            "telephone_number": "703-502-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSA",
        "first_name": "LISHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-07",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101058868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

Verify at the official NPI Registry.