Individual provider Active NPI

Samuel CHI Achu, LCSW

  • Clinical Social Worker
  • Fairfax, VA
National Provider Identifier
1518484443
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904009958 Issued in VA
Practice address
8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone
(703) 219-2565
Fax
(703) 653-6682
NPI assigned
Aug 22, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904009958 VA Primary

Addresses

Primary practice location

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512

Mailing address

8221 Willow Oaks Corporate Dr
Fairfax, VA 22031-4512
Phone (703) 219-2565

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171110001732 DC Practitioner - Clinical Social Worker 1254697048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12011 Goverment Ctr Pkwy
Suite 836
Fairfax, VA 22035-1100
Phone (703) 324-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0904009958VAMDClinical Social Worker

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1518484443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-219-2565",
            "fax_number": "703-653-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8221 WILLOW OAKS CORPORATE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314512",
            "telephone_number": "703-219-2565",
            "fax_number": "703-653-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACHU",
        "first_name": "SAMUEL",
        "middle_name": "CHI",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.