Individual provider Active NPI

Mala Bakshi Mehta, M.D.

  • Rheumatology Physician
  • Fairfax, VA
National Provider Identifier
1881744324
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
0101229837 Issued in VA
Practice address
12011 Lee Jackson Memorial Hwy
4TH Floor
Fairfax, VA 22033-3310
Phone
(703) 383-5458
Fax
(703) 383-5519
NPI assigned
Jan 10, 2007
Last updated
Jun 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X D0050953 MD
Rheumatology Physician 207RR0500X 0101229837 VA Primary

Addresses

Primary practice location

12011 Lee Jackson Memorial Hwy
4TH Floor
Fairfax, VA 22033-3310

Mailing address

2101 East Jefferson Street
Kaiser Permanente, Ppqa, 6 West, Attn: Theresa Brooks
Rockville, MD 20852
Phone (301) 816-6660

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

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: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040521001223 DC Practitioner - Internal MedicinePractitioner - Rheumatology 4385635838 Reassigns benefits to 1 organization
I20181218001139 VA Practitioner - Internal MedicinePractitioner - Rheumatology 4385635838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Rheumatology
Education
Louisiana State University School of Medicine in New Orleans, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1201 Hospital Dr
Fredericksburg, VA 22401-8428
Phone (540) 368-3700

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

201 N Washington St
Falls Church, VA 22046-4518
Phone (703) 237-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0050953MDMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Oct 20, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Rheumatology Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Oct 12, 2001 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Oct 12, 2001 Accepting new patients

Locations

2101 E Jefferson St
#6W
Rockville, MD 20852
Phone (301) 816-6660

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
Ste 6W
Rockville, MD 20852
Phone (301) 816-5853

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

12255 Fair Lakes Pkwy
Fairfax, VA 22033
Phone (703) 934-5700

201 N Washington St
Falls Church, VA 22046
Phone (703) 237-4000

1201 Hospital Dr
Fredericksburg, VA 22401
Phone (540) 368-3700

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1881744324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 EAST JEFFERSON STREET",
            "address_2": "KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "20852",
            "telephone_number": "301-816-6660",
            "fax_number": "301-816-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12011 LEE JACKSON MEMORIAL HWY",
            "address_2": "4TH FLOOR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333310",
            "telephone_number": "703-383-5458",
            "fax_number": "703-383-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "MALA",
        "middle_name": "BAKSHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MD",
            "license": "D0050953",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "VA",
            "license": "0101229837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "201 N Washington St",
            "city": "Falls Church",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220464518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.