Shelby Kloosterboer

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110007652 Issued in VA

Practice address

46440 Benedict Drive, Suite 107
Sterling, VA 20164-6602

Phone

(703) 450-1125

Fax

(703) 450-1145

NPI assigned

Feb 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD, DC, VA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Inova Ucc LLCGroup PAC ID 7012385040, 158 clinicians

Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Inova Loudoun Hospital Hospital, Leesburg, VA, CCN 490043

Merit-based Incentive Payment System (MIPS)

Final score

92.65 of 100Reported as apm

Quality

85.31

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: svought1291676@soc.inova.org
• Direct secure messaging: shelby.kloosterboer@lmg1.eclinicaldirectplus.com

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.

• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440
  Medicare reassignment Care Compare group NPD
• Inova Ucc LLC

  • Urgent Care Clinic/Center
  • Vienna, VA
  • NPI 1508592114

  DC

  Medicare reassignment Care Compare group
• MGMC, LLC

  • General Practice Physician
  • Washington, DC
  • NPI 1891797148

  MD

  Medicare reassignment
• Loudoun Medical Group, PC

  dba Loudoun Medical Group, PC 'D'

  • Vascular Surgery Physician
  • Reston, VA
  • NPI 1588376321
  NPD
• Medstar Medical Group II LLC

  • General Practice Physician
  • Brandywine, MD
  • NPI 1285064550
  NPD

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

• Inova Health Care Services

  dba Inova Loudoun Hospital

  • Psychiatric Hospital Unit
  • Leesburg, VA
  • NPI 1285786228
  Care Compare affiliation
• Inova Health Care Services

  dba Inova Loudoun Hospital

  • General Acute Care Hospital
  • Leesburg, VA
  • NPI 1376564302
  Care Compare affiliation

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

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1679105530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL STREET, NW, SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46440 BENEDICT DRIVE, SUITE 107",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201646602",
            "telephone_number": "703-450-1125",
            "fax_number": "703-450-1145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6355 Walker Ln Ste 501",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223103251",
            "country_code": "US",
            "telephone_number": "703-971-3701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13950 Brandywine Rd Ste 225",
            "address_purpose": "LOCATION",
            "city": "Brandywine",
            "state": "MD",
            "postal_code": "206135815",
            "country_code": "US",
            "telephone_number": "812-584-8922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "46440 Benedict Drive",
            "address_2": "Suite 107",
            "address_purpose": "LOCATION",
            "city": "Sterling",
            "state": "VA",
            "postal_code": "201646602",
            "country_code": "US",
            "telephone_number": "703-450-1125",
            "fax_number": "703-450-1145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLOOSTERBOER",
        "first_name": "SHELBY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-10",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30016389950001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679105530",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey King
• Damara Joi Kippins-Graham
• Keyona Kirlew
• KKMP Inc
• Morgan Elizabeth Klein, PA-C
• Suzanna Klyber, OTR/L
• Tony A Knapp, D.C.
• Emily Knear, PHARMD
• Marjorie Knight, LPC
• Rosa Maria Knight

• Physician Assistant in Sterling, VA
• Providers in Sterling, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.

Verify at the official NPI Registry.