NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

Doing business as Penderbrook Medical Center Laboratory

  • Anatomic Pathology & Clinical Pathology Physician
  • Fairfax, VA
National Provider Identifier
1568520070
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Doing business as
Penderbrook Medical Center Laboratory
Practice address
12011 Lee Jackson Highway
Fairfax, VA 22033-3310
Phone
(703) 257-3050
Fax
(703) 257-3042
NPI assigned
Dec 5, 2006
Last updated
Jul 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Authorized official

Name
Mrs. Colleen E Swinton
Title
Credentialing Director
Phone
(301) 257-2797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

12011 Lee Jackson Highway
Fairfax, VA 22033-3310

Mailing address

4000 Garden City Dr
Hyattsville, MD 20785-2418
Phone (301) 816-2424

Other names 1

  • Penderbrook Medical Center Laboratory Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Georgetown Comm169 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1568520070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 GARDEN CITY DR",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207852418",
            "telephone_number": "301-816-2424",
            "fax_number": "301-816-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12011 LEE JACKSON HIGHWAY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333310",
            "telephone_number": "703-257-3050",
            "fax_number": "703-257-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "SWINTON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "301-257-2797",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "815 E Pratt St",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212024402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Penderbrook Medical Center Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Penderbrook Medical Center Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.