LAKE RIDGE INTERNAL MEDICNE, PC
NPI 1316163256
Internal Medicine in Woodbridge, VA
About Lake Ridge Internal Medicne, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE RIDGE INTERNAL MEDICNE, PC (NPI 1316163256) is a healthcare organization registered as an internal medicine in Woodbridge, Virginia and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through May 27, 2028 and lists Bassam Farah, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake Ridge Internal Medicne, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lake Ridge Internal Medicne, PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 49D1026249
Lake Ridge Internal Medicine · Woodbridge, VAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lake Ridge Internal Medicne, PC's NPI number?
The NPI number for Lake Ridge Internal Medicne, PC is 1316163256. It was assigned to this organization in the NPPES registry on April 18, 2007.
Where is Lake Ridge Internal Medicne, PC located?
Lake Ridge Internal Medicne, PC is located at 1725 Financial Loop, Woodbridge, VA 22192. The listed phone number is (703) 492-1108.
What is Lake Ridge Internal Medicne, PC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Lake Ridge Internal Medicne, PC enrolled in Medicare?
Yes. Lake Ridge Internal Medicne, PC is registered in the Medicare PECOS enrollment system.
When is Lake Ridge Internal Medicne, PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Virginia, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lake Ridge Internal Medicne, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Lake Ridge Internal Medicne, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lake Ridge Internal Medicne, PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 49D1026249) is associated with this NPI, valid through May 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Lake Ridge Internal Medicne, PC was last updated on April 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lake Ridge Internal Medicne, Pc · NPI 1316163256
Internal Medicine organization in Woodbridge, Virginia. Organization record, active in the CMS NPPES registry since April 18, 2007.
## Identity
- **NPI:** 1316163256 (Entity type: Organization)
- **Enumerated:** April 18, 2007
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Bassam Farah, PRESIDENT
## Practice location
- **Address:** 1725 FINANCIAL LOOP, Woodbridge, VA 22192-2460
- **Phone:** (703) 492-1108
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Virginia, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Internal Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 16, 2012
- **Other identifiers:** Medicare ID-Type Unspecified C09155 (VA); Medicare UPIN G38010 (VA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1316163256) · Data from the CMS NPPES public registry.