Advanced Internal Medicine, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0101059082 Issued in VA

Legal business name

ADVANCED INTERNAL MEDICINE, INC.

Practice address

3930 Pender Dr
Suite 230
Fairfax, VA 22030-0985

Phone

(703) 620-6221

Fax

(703) 620-6628

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Mubarik Khan, MDNPI 1336169598

Title

President

Phone

(703) 620-6221

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

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

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mubarik Khan, MD

  • Specialist
  • Fairfax, VA
  • NPI 1336169598

  DC, Specialist

  Medicare reassignment NPD Authorized official
• Shaveta Goyal, M.D.

  • Family Medicine Physician
  • Fairfax, VA
  • NPI 1215248109

  DC

  Medicare reassignment NPD
• Khairunnisa Masood, MD

  • Internal Medicine Physician
  • Fairfax, VA
  • NPI 1093731499

  DC, Specialist

  Medicare reassignment NPD
• Shahid Nasir Malik, MD

  • Hospitalist Physician
  • Johnson City, NY
  • NPI 1912927161
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1366468779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 PENDER DR",
            "address_2": "SUITE 230",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300985",
            "telephone_number": "703-620-6221",
            "fax_number": "703-620-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 PENDER DR",
            "address_2": "SUITE 230",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300985",
            "telephone_number": "703-620-6221",
            "fax_number": "703-620-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED INTERNAL MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "MUBARIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-620-6221",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101059082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fairfax, VA
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.