Organization Active NPI

Hispanic American Pediatric Associates

  • Primary Care Clinic/Center
  • Alexandria, VA
National Provider Identifier
1386719524
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
40990-01 Issued in VA
Legal business name
HISPANIC AMERICAN PEDIATRIC ASSOCIATES
Practice address
5130 Duke Street
Suite 7
Alexandria, VA 22304-7207
Phone
(703) 751-2021
Fax
(703) 751-2071
NPI assigned
Nov 22, 2006
Last updated
Jan 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Dr. Jemal Omidvar, M.DNPI 1992755276
Title
President
Phone
(703) 751-2021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 40990-01 VA Primary

Addresses

Primary practice location

5130 Duke Street
Suite 7
Alexandria, VA 22304-7207

Mailing address

5130 Duke St Ste 7
Suite 229
Alexandria, VA 22304-2955
Phone (703) 751-2021

Other identifiers 3

IdentifierTypeStateIssuer
010125561MedicaidVA
002632800MedicaidMD
010117534MedicaidVA

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
49D1037007Hispanic American Pediatric Associates5130 Duke Street - Suite 7, Alexandria, VA 22304Certificate of waiverFeb 13, 2027

National Provider Directory

National Provider Directory

Locations

5130 Duke St
Ste 7
Alexandria, VA 22304
Phone (703) 370-2345

Practitioners & affiliated clinicians

Practitioners 2

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": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1386719524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5130 DUKE ST STE 7",
            "address_2": "SUITE 229",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042955",
            "telephone_number": "703-751-2021",
            "fax_number": "703-751-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 DUKE STREET",
            "address_2": "SUITE 7",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223047207",
            "telephone_number": "703-751-2021",
            "fax_number": "703-751-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HISPANIC AMERICAN PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "OMIDVAR",
        "authorized_official_first_name": "JEMAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-751-2021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "40990-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010125561",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002632800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010117534",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.