NPIMap

Individual provider Active NPI

Khalid Mahdi Shumburo, M.D.

  • Nephrology Physician
  • Fairfax, VA
National Provider Identifier
1952379737
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0101233836 Issued in VA
Practice address
13135 Lee Jackson Memorial Hwy
#135
Fairfax, VA 22033-1907
Phone
(703) 961-0488
Fax
(703) 961-0480
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 0101233836 VA Primary

Addresses

Primary practice location

13135 Lee Jackson Memorial Hwy
#135
Fairfax, VA 22033-1907

Mailing address

13135 Lee Jackson Memorial Hwy
#135
Fairfax, VA 22033-1907
Phone (703) 961-0488

Other identifiers 1

IdentifierTypeStateIssuer
010298016MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040126000285 DC Practitioner - NephrologyPractitioner - Internal Medicine 7214839604 Reassigns benefits to 1 organization
I20060418000422 VA Practitioner - NephrologyPractitioner - Internal Medicine 7214839604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Texas Southwestern Medical School at Dallas, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates of Northern Virginia IncGroup PAC ID 4587566138, 15 clinicians

Practice addresses (Care Compare)

13135 Lee Jackson Hwy
Suite 135
Fairfax, VA 22033-1907
Phone (703) 476-1740

46396 Benedict Dr
Suite 220
Sterling, VA 20164-6626
Phone (703) 476-1740

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101233836VAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates of Northern Virginia, Inc Nephrology CurrentSince Jul 1, 2006 Accepting new patients
Lucy Webb Hayes National Training School for Deaconsses & Missonaries Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Hospital Physician Services, LLLP Nephrology Past Accepting new patients

Locations

1800 N Beauregard St
Ste 80
Alexandria, VA 22311
Phone (703) 961-0488

5695 King Centre Dr
Ste 105
Alexandria, VA 22315
Phone (703) 921-9506

8501 Arlington Blvd
Ste 100
Fairfax, VA 22031
Phone (703) 876-8445

13135 Route 50
Ste 135
Fairfax, VA 22033
Phone (703) 961-0488

13135 Route 50
Fairfax, VA 22033
Phone (703) 391-0900

14664 Gap Way
Gainesville, VA 20155
Phone (703) 753-3520

530 Huntmar Park Dr
Herndon, VA 20170

44084 Riverside Pkwy
Ste 250
Leesburg, VA 20176
Phone (304) 449-3778

8405 Dorsey Cir
Ste 102
Manassas, VA 20110
Phone (703) 208-0820

46396 Benedict Dr
Ste 220
Sterling, VA 20164

2751 Killarney Dr
Woodbridge, VA 22192
Phone (703) 897-7027

Interoperability endpoints

  • Direct secure messaging: khalidshumburo@nanv.allscriptsdirect.net
  • Direct secure messaging: khalid.shumburo@direct.davitaphysiciansolutions.com

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1952379737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON MEMORIAL HWY",
            "address_2": "#135",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-961-0488",
            "fax_number": "703-961-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON MEMORIAL HWY",
            "address_2": "#135",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-961-0488",
            "fax_number": "703-961-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMBURO",
        "first_name": "KHALID",
        "middle_name": "MAHDI",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "VA",
            "license": "0101233836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010298016",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.