Legacy Dialysis of Fairfax LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

LEGACY DIALYSIS OF FAIRFAX LLC

Practice address

10565 Fairfax Blvd Ste 205
Fairfax, VA 22030-3104

Phone

(571) 340-3221

Fax

(571) 340-3404

NPI assigned

Jul 17, 2018

Last updated

Feb 26, 2025By 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

Ms. Myrlene Barrera

Title

Director

Phone

(305) 778-8277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Listed as

Legacy Dialysis Of FairfaxCCN 492737

Overall star rating

4.0 of 5

Ownership

Profit

Certified

May 20, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

3

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

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Eugene H Kim, MD

  • Nephrology Physician
  • Manassas, VA
  • NPI 1346277969

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1427534072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 E SAMPLE RD STE 301",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330643552",
            "telephone_number": "954-781-7741",
            "fax_number": "888-349-8679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10565 FAIRFAX BLVD STE 205",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220303104",
            "telephone_number": "571-340-3221",
            "fax_number": "571-340-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DIALYSIS OF FAIRFAX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "BARRERA",
        "authorized_official_first_name": "MYRLENE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "305-778-8277",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Won Jin Lee, LPC
• Yeji Lee
• Yongmin Lee, D.C
• Young Jin Lee
• John Leslie Leech
• Elizabeth Legg
• Bobbi Ann Lehman, CRNP
• Stefan W Leichtle, M.D.
• Jane Shelley Leifer, LCSW-C
• Zachary Leiner, D.D.S.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.