NPIMap

Organization Active NPI

Fairfax Family Practice Centers PC

Doing business as Broadlands Family Practice at Brambleton

  • Family Medicine Physician
  • Brambleton, VA
National Provider Identifier
1871762849
Registry record updated Feb 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAIRFAX FAMILY PRACTICE CENTERS PC
Doing business as
Broadlands Family Practice at Brambleton
Practice address
22895 Brambleton Place
Suite 200
Brambleton, VA 20148
Phone
(703) 726-0003
Fax
(703) 726-6444
NPI assigned
Feb 25, 2008
Last updated
Feb 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2008

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

Authorized official

Name
James P Jenkins, MDNPI 1023002177
Title
President
Phone
(703) 255-9100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

22895 Brambleton Place
Suite 200
Brambleton, VA 20148

Mailing address

22895 Brambleton Place
Suite 200
Brambleton, VA 20148
Phone (703) 726-0003

Other names 1

  • Broadlands Family Practice at Brambleton Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1084820Broadlands Family Practice-Brambleton22895 Brambleton Plaza - Suite 200, Ashburn, VA 20148Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Fairfax Family Practice10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

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": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1871762849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22895 BRAMBLETON PLACE",
            "address_2": "SUITE 200",
            "city": "BRAMBLETON",
            "state": "VA",
            "postal_code": "20148",
            "telephone_number": "703-726-0003",
            "fax_number": "703-726-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22895 BRAMBLETON PLACE",
            "address_2": "SUITE 200",
            "city": "BRAMBLETON",
            "state": "VA",
            "postal_code": "20148",
            "telephone_number": "703-726-0003",
            "fax_number": "703-726-6444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX FAMILY PRACTICE CENTERS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-255-9100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadlands Family Practice at Brambleton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brambleton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.