Active NPI
Dinara Yambulatova, MPAS, PA
- Physician Assistant
- MC Lean, VA
National Provider Identifier
1457740441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110004891
- Practice address
- 6849 Old Dominion Dr Ste 315
MC Lean, VA 22101-3733 - Phone
- (571) 378-1398
- Fax
- (571) 580-0620
- NPI assigned
- Jan 14, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110004891 | VA | Primary |
Addresses
Primary practice location
6849 Old Dominion Dr Ste 315
MC Lean, VA 22101-3733
Mailing address
6849 Old Dominion Dr Ste 315
MC Lean, VA 22101-3733
Phone (571) 378-1398
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
6849 Old Dominion Dr
Suite 315
MC Lean, VA 22101-3733
Phone (571) 378-1398
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110004891 | VA | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- Behavioral Neurology & Neuropsychiatry Physician
- MC Lean, VA
- NPI 1356935597
DC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739923200000",
"number": "1457740441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6849 OLD DOMINION DR STE 315",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221013733",
"telephone_number": "571-378-1398",
"fax_number": "571-580-0620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6849 OLD DOMINION DR STE 315",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221013733",
"telephone_number": "571-378-1398",
"fax_number": "571-580-0620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAMBULATOVA",
"first_name": "DINARA",
"credential": "MPAS, PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-14",
"last_updated": "2025-02-19",
"certification_date": "2025-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110004891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.
- 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.