NPIMap

Organization Active NPI

Phenom Surgical LLC

  • Surgery Physician
  • Fairfax, VA
National Provider Identifier
1871842989
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PHENOM SURGICAL LLC
Practice address
2750 Prosperity Ave
#120
Fairfax, VA 22031-4312
Phone
(703) 659-4557
Fax
(703) 205-9010
NPI assigned
Sep 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

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

Authorized official

Name
Mr. Thomas Lamont Hegens, LCSA
Title
Owner/Ceo
Phone
(703) 659-4557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

2750 Prosperity Ave
#120
Fairfax, VA 22031-4312

Mailing address

8116 Arlington Blvd
#183
Falls Church, VA 22042-1002
Phone (703) 659-4557

Other identifiers 2

IdentifierTypeStateIssuer
2906OtherVANATIONAL SURGICAL ASSISTANT ASSOCIATION
SA0017OtherDCDEPARTMENT OF HEALTH, HEALTH PROFESSIONAL LICENSING ADMINISTRATION

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1871842989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8116 ARLINGTON BLVD",
            "address_2": "#183",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220421002",
            "telephone_number": "703-659-4557",
            "fax_number": "703-205-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 PROSPERITY AVE",
            "address_2": "#120",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314312",
            "telephone_number": "703-659-4557",
            "fax_number": "703-205-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHENOM SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-05",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "HEGENS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "LAMONT",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "703-659-4557",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL SURGICAL ASSISTANT ASSOCIATION",
            "identifier": "2906",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH, HEALTH PROFESSIONAL LICENSING ADMINISTRATION",
            "identifier": "SA0017",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; 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.