Individual provider Active NPI

Chinwe Edith Agbim

  • Family Nurse Practitioner
  • Woodbridge, VA
National Provider Identifier
1831616010
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024170435 Issued in VA
Practice address
12716 Directors Loop
Woodbridge, VA 22192-2462
Phone
(703) 730-7815
NPI assigned
Aug 28, 2017
Sex
Female
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
Family Nurse Practitioner 363LF0000X 0024170435 VA Primary

Addresses

Primary practice location

12716 Directors Loop
Woodbridge, VA 22192-2462

Mailing address

12716 Directors Loop
Woodbridge, VA 22192-2462
Phone (703) 282-3959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20200407000098 DC Practitioner - Nurse Practitioner 5698104081 Reassigns benefits to 2 organizations
I20200408001828 VA Practitioner - Nurse Practitioner 5698104081 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024170435VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ennoble HC DMV LLC CurrentSince Sep 1, 2024 Accepting new patients
Medical Clinic of Woodbridge Inc CurrentSince Jul 24, 2022 Accepting new patients
Rahel G. Yirga MD PC CurrentSince Mar 1, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2 University Plz
Ste 204
Hackensack, NJ 07601
Phone (201) 564-0142

20130 Lakeview Center Plz
Ste 400
Ashburn, VA 20147
Phone (700) 865-2144

6035 Burke Centre Pkwy
Ste 390
Burke, VA 22015
Phone (703) 978-0756

20 Pidgeon Hill Dr
Ste 208
Sterling, VA 20165
Phone (703) 539-6029

12716 Directors Loop
Woodbridge, VA 22192
Phone (703) 497-1964

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1831616010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12716 DIRECTORS LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-282-3959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12716 DIRECTORS LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922462",
            "telephone_number": "703-730-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBIM",
        "first_name": "CHINWE",
        "middle_name": "EDITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024170435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.