NPIMap

Organization Active NPI

Vascular Institute of Virginia LLC

  • Nephrology Physician
  • Woodbridge, VA
National Provider Identifier
1942509989
Registry record updated Jan 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
VASCULAR INSTITUTE OF VIRGINIA LLC
Practice address
14085 Crown CT
Woodbridge, VA 22193-1458
Phone
(703) 763-5224
Fax
(703) 763-5374
NPI assigned
Mar 16, 2011
Last updated
Jan 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2015

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

Authorized official

Name
Dr. Anish P Shah, M.D., F.A.S.N.NPI 1699790436
Title
President
Phone
(215) 828-2387

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
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

14085 Crown CT
Woodbridge, VA 22193-1458

Mailing address

14085 Crown CT
Woodbridge, VA 22193-1458
Phone (703) 763-5224

Other identifiers 2

IdentifierTypeStateIssuer
1942509989MedicaidVA
312008200MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110729000527 VA Part B Supplier - Clinic/Group Practice 4587832944 Receives reassigned benefits from 9 practitioners
Practice locations: Fredericksburg, VA; Woodbridge, VA
O20150915002932 DC Part B Supplier - Clinic/Group Practice 4587832944 Receives reassigned benefits from 13 practitioners
Practice locations: Fairfax, VA; Alexandria, VA

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
49D2073917Vascular Institute Virginia14085 Crown Court, Woodbridge, VA 22193Certificate of waiverFeb 25, 2028

National Provider Directory

National Provider Directory

Locations

101 Hospice Ln
Winston Salem, NC 27103
Phone (336) 768-3972

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420588800000",
    "number": "1942509989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14085 CROWN CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221931458",
            "telephone_number": "703-763-5224",
            "fax_number": "703-763-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14085 CROWN CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221931458",
            "telephone_number": "703-763-5224",
            "fax_number": "703-763-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR INSTITUTE OF VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2015-01-07",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "ANISH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-828-2387",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., F.A.S.N."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942509989",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312008200",
            "state": "MD"
        }
    ],
    "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 Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.