Carlos Fagbenro, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024169586 Issued in VA

Practice address

6360 Hoadly Rd
Manassas, VA 20112-3422

Phone

(571) 594-9110

NPI assigned

Dec 7, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Well-Care Corp

  • Family Nurse Practitioner
  • Woodbridge, VA
  • NPI 1952853061

  Family, VA

  Medicare reassignment NPD Authorized official
• Mednovations LLC

  • Primary Care Clinic/Center
  • Woodbridge, VA
  • NPI 1013402593

  DC, VA

  Medicare reassignment NPD

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1447528328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15337 LORD CULPEPER CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914937",
            "telephone_number": "571-594-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 HOADLY RD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201123422",
            "telephone_number": "571-594-9110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGBENRO",
        "first_name": "CARLOS",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-07",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024169586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eunice Song, DDS, PC
• Evergreen Homecare LLC
• Evergreen Neurology and Sleep Center
• Deborah Sue Everist
• Chizimako Margaret Eze, NP
• Mary Lou Fahey, LCSW
• Fairfax Family Prac Cen
• Fairfax Pathology Associates, LTD.
• Fairland by Medical Transportation LLC
• Abdul Ahad Faisal, MD

• All providers in Manassas, VA
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.