NPIMap

Individual provider Active NPI

Kourosh Dibadj, M.D.

  • Nephrology Physician
  • Fairfax, VA
National Provider Identifier
1487716593
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101241367 Issued in VA
Practice address
13135 Lee Jackson Memorial Hwy
135
Fairfax, VA 22033-1907
Phone
(703) 961-0488
Fax
(703) 961-0480
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 0101241367 VA Primary

Addresses

Primary practice location

13135 Lee Jackson Memorial Hwy
135
Fairfax, VA 22033-1907

Mailing address

13135 Lee Jackson Memorial Hwy
135
Fairfax, VA 22033-1907
Phone (703) 961-0488

Other identifiers 1

IdentifierTypeStateIssuer
1487716593MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080407000500 DC Practitioner - Nephrology 6507858636 Reassigns benefits to 1 organization
I20080407000525 VA Practitioner - Nephrology 6507858636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Northern Virginia Inc 15 clinicians

Practice addresses (Care Compare)

13135 Lee Jackson Hwy
Suite 135
Fairfax, VA 22033-1907
Phone (703) 476-1740

2751 Killarney Dr
Woodbridge, VA 22192-4172
Phone (703) 476-1740

Hospital & facility affiliations

  • DaVita CDC of Woodbridge Dialysis facility, Woodbridge, VA, CCN 492521
  • DaVita Dale City Dialysis facility, Dale City, VA, CCN 492689
  • Sentara Northern Virginia Medical Center Hospital, Woodbridge, VA, CCN 490113
  • Inova Alexandria Hospital Hospital, Alexandria, VA, CCN 490040
  • Inova Fairfax Hospital Hospital, Falls Church, VA, CCN 490063
  • Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022
  • Inova Mount Vernon Hospital Hospital, Alexandria, VA, CCN 490122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Northern Virginia, Inc Nephrology CurrentSince Jul 1, 2007 Accepting new patients
Shands Teaching Hospital and Clinics Inc Past Accepting new patients

Locations

5695 King Centre Dr
Ste 105
Alexandria, VA 22315
Phone (703) 921-9506

8501 Arlington Blvd
Ste 100
Fairfax, VA 22031
Phone (703) 876-8445

13135 Route 50
Fairfax, VA 22033
Phone (703) 391-0900

13135 Route 50
Ste 135
Fairfax, VA 22033
Phone (703) 961-0488

14664 Gap Way
Gainesville, VA 20155
Phone (703) 753-3520

530 Huntmar Park Dr
Herndon, VA 20170

44084 Riverside Pkwy
Ste 250
Leesburg, VA 20176
Phone (304) 449-3778

8405 Dorsey Cir
Ste 102
Manassas, VA 20110
Phone (703) 208-0820

46396 Benedict Dr
Ste 220
Sterling, VA 20164

2751 Killarney Dr
Woodbridge, VA 22192
Phone (703) 897-7027

Interoperability endpoints

  • Direct secure messaging: kouroshdibadj@nanv.allscriptsdirect.net
  • Direct secure messaging: kourosh.dibadj@direct.davitaphysiciansolutions.com

Organizations & group practices 2

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1487716593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON MEMORIAL HWY",
            "address_2": "135",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-961-0488",
            "fax_number": "703-961-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON MEMORIAL HWY",
            "address_2": "135",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-961-0488",
            "fax_number": "703-961-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBADJ",
        "first_name": "KOUROSH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101241367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487716593",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.