NPIMap

Organization Active NPI

Fairfax Colon & Rectal Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Fairfax, VA
National Provider Identifier
1306957485
Registry record updated Dec 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
FAIRFAX COLON & RECTAL SURGERY CENTER, LLC
Practice address
2710 Prosperity Ave Ste 200
Fairfax, VA 22031
Phone
(703) 280-2841
Fax
(703) 650-2322
NPI assigned
Aug 31, 2006
Last updated
Dec 4, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRFAX COLON & RECTAL SURGERY, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2013

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

Authorized official

Name
Mr. Michael Delac, CMPE
Title
Administrator
Phone
(703) 650-2333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Colon & Rectal Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208C00000X
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

2710 Prosperity Ave Ste 200
Fairfax, VA 22031

Mailing address

2710 Prosperity Ave Ste 200
Fairfax, VA 22031
Phone (703) 280-2841

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0949345Fairfax Colon Rectal Surgery PC2710 Prosperity Avenue - Suite 200, Fairfax, VA 22031Certificate of waiverJul 30, 2026
49D1061146Fairfax Colon & Rectal Surgical Center2710 Prosperity Avenue, Fairfax, VA 22031Certificate of waiverNov 8, 2026

National Provider Directory

National Provider Directory
Part of
Fairfax Colon Rectal Surge

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAEJBD

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386115200000",
    "number": "1306957485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 PROSPERITY AVE STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-280-2841",
            "fax_number": "703-650-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 PROSPERITY AVE STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-280-2841",
            "fax_number": "703-650-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX COLON & RECTAL SURGERY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRFAX COLON & RECTAL SURGERY, PC",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-12-04",
        "status": "A",
        "authorized_official_last_name": "DELAC",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-650-2333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CMPE"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.