Organization Active NPI

New Life Medical LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Woodbridge, VA
National Provider Identifier
1811463086
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
NEW LIFE MEDICAL LLC
Practice address
2300 Opitz Blvd
Woodbridge, VA 22191-3311
Phone
(703) 523-1000
NPI assigned
Oct 16, 2018
Last updated
Oct 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

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

Authorized official

Name
Nebiyu Biru, MDNPI 1780983320
Title
Critical Care Medicine
Phone
(732) 939-7248

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU Primary

Addresses

Primary practice location

2300 Opitz Blvd
Woodbridge, VA 22191-3311

Mailing address

3025 Nassau Dr
Brookfield, WI 53045-3454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190131001341 VA Part B Supplier - Clinic/Group Practice 5799022505 Receives reassigned benefits from 1 practitioner
Practice locations: Woodbridge, VA

National Provider Directory

National Provider Directory

Locations

2300 Opitz Blvd
Ste 1258
Woodbridge, VA 22191

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539648000000",
    "number": "1811463086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 NASSAU DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530453454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 OPITZ BLVD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913311",
            "telephone_number": "703-523-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-16",
        "last_updated": "2018-10-16",
        "status": "A",
        "authorized_official_last_name": "BIRU",
        "authorized_official_first_name": "NEBIYU",
        "authorized_official_title_or_position": "CRITICAL CARE MEDICINE",
        "authorized_official_telephone_number": "732-939-7248",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.