Chantilly Walk-in Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0101036326 Issued in VA

Legal business name

CHANTILLY WALK-IN CLINIC

Practice address

13037 Lee Jackson Hwy
Ste D
Fairfax, VA 22033-2004

Phone

(703) 631-0791

Fax

(703) 968-4227

NPI assigned

Jun 24, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Samir Nazam, M.D.NPI 1578684841

Title

Physician

Phone

(703) 631-0791

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 3

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

• Samir Nazam, M.D.

  • Family Medicine Physician
  • Fairfax, VA
  • NPI 1578684841

  DC

  Medicare reassignment NPD Authorized official
• Tracy Bishop Devany, ARNP

  • Family Nurse Practitioner
  • Virginia Beach, VA
  • NPI 1649258849
  NPD
• Jennifer R Francisco, FNP BC

  • Family Nurse Practitioner
  • Leesburg, VA
  • NPI 1861944837
  NPD (past)

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972509735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221226",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201531226",
            "telephone_number": "703-631-0791",
            "fax_number": "703-968-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13037 LEE JACKSON HWY",
            "address_2": "STE D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332004",
            "telephone_number": "703-631-0791",
            "fax_number": "703-968-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANTILLY WALK-IN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NAZAM",
        "authorized_official_first_name": "SAMIR",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "703-631-0791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0101036326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B/C PROVIDER #",
            "identifier": "292549",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jhia-Ming Chang, DDS
• Raymond Chang, MD
• Wellington H. Chang, M.D.
• Changepath ABA Therapy
• Courtney Johns Channels
• Catherine S Chao, M.D.
• Ava C Chapman
• Gloria Jean Chapman, RN
• Jenna Elizabeth Chapman, PA-C
• Tobias Robert Chapman, M.D.

• Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.