NPIMap

Organization Active NPI

Alexandria Lake Ridge Pediatrics

  • Pediatrics Physician
  • Alexandria, VA
National Provider Identifier
1649215955
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
101038289 Issued in VA
Legal business name
ALEXANDRIA LAKE RIDGE PEDIATRICS
Practice address
1500 N Beauregard St Ste 200
Alexandria, VA 22311-1700
Phone
(703) 436-1200
Fax
(703) 499-9670
NPI assigned
Jun 19, 2006
Last updated
Apr 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Authorized official

Name
Karen Hoffer
Title
Clinical Administrtor
Phone
(703) 436-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 101038289 VA Primary

Addresses

Primary practice location

1500 N Beauregard St Ste 200
Alexandria, VA 22311-1700

Mailing address

1500 N Beauregard St Ste 200
Alexandria, VA 22311-1700
Phone (703) 436-1200

Other practice location 1

9010 Lorton Station Blvd Ste 100
Lorton, VA 22079-4796
Phone (703) 436-1200

Other practice location 2

4500 Pond Way Ste 220
Woodbridge, VA 22192-7825
Phone (703) 436-1200

Other identifiers 9

IdentifierTypeStateIssuer
6738206MedicaidVA
6738214MedicaidVA
6792896MedicaidVA
6704999MedicaidVA
6733816MedicaidVA
010077036MedicaidVA
6721001MedicaidVA
6737935MedicaidVA
6719694MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Alexandria Lake Ridge Pediatrics5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1500 N Beauregard St
Ste 20
Alexandria, VA 22311

9010 Lorton Station Blvd
Lorton, VA 22079
Phone (703) 337-1550

9010 Lorton Station Blvd
Ste 1
Lorton, VA 22079

9010 Lorton Station Blvd
Ste 100
Lorton, VA 22079
Phone (703) 436-1200

4500 Pond Way
Ste 202
Woodbridge, VA 22192

4500 Pond Way
Ste 220
Woodbridge, VA 22192
Phone (703) 436-1200

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649894400000",
    "number": "1649215955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N BEAUREGARD ST STE 200",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111700",
            "telephone_number": "703-436-1200",
            "fax_number": "703-499-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N BEAUREGARD ST STE 200",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223111700",
            "telephone_number": "703-436-1200",
            "fax_number": "703-499-9670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9010 Lorton Station Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lorton",
            "state": "VA",
            "postal_code": "220794796",
            "country_code": "US",
            "telephone_number": "703-436-1200",
            "fax_number": "703-499-9670",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 Pond Way Ste 220",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221927825",
            "country_code": "US",
            "telephone_number": "703-436-1200",
            "fax_number": "703-499-9670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALEXANDRIA LAKE RIDGE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "HOFFER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CLINICAL ADMINISTRTOR",
        "authorized_official_telephone_number": "703-436-1200"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "101038289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6738206",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6738214",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6792896",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6704999",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6733816",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010077036",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6721001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6737935",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6719694",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.