DR. JACK KITAEFF PH.D.
NPI 1518300201
Psychologist - Clinical in Fairfax, VA
About Dr. Jack Kitaeff Ph.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACK KITAEFF PH.D. (NPI 1518300201) is an individual clinical provider in Fairfax, Virginia, licensed in Virginia (1070) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS and is a graduate of University Of Mississippi School Of Medicine (1978).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Jack Kitaeff Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jack Kitaeff reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Fairfax, VA 22030
- Reassigned Medicare billing, District of Columbia enrollment
- 15 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 22030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FAIRFAX, VA 22030
Frequently 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 Jack Kitaeff's NPI number?
The NPI number for Jack Kitaeff is 1518300201. It was assigned to this individual provider in the NPPES registry on April 11, 2013.
Where is Jack Kitaeff located?
Jack Kitaeff practices at 10560 Main St Suite 518, Fairfax, VA 22030. The listed phone number is (703) 349-2999.
What is Jack Kitaeff's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Jack Kitaeff enrolled in Medicare?
Yes. Jack Kitaeff is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jack Kitaeff's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Kitaeff reassigns Medicare benefits to Clinical Psychology Services PC (Fairfax, VA). The 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 Jack Kitaeff's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jack Kitaeff accept?
Health plans from Oscar Health list Jack Kitaeff as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jack Kitaeff was last updated on September 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# Dr. Jack Kitaeff, PH.D. · NPI 1518300201
Clinical provider in Fairfax, Virginia. Individual provider, active in the CMS NPPES registry since April 11, 2013.
## Identity
- **NPI:** 1518300201 (Entity type: Individual)
- **Enumerated:** April 11, 2013
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** 1070 (Virginia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 10560 MAIN ST, SUITE 518, Fairfax, VA 22030-7182
- **Phone:** (703) 349-2999
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Clinical Psychology Services PC (NPI 1194818054, Fairfax, VA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Mississippi School Of Medicine, class of 1978
## Record status
- **NPPES last updated:** September 29, 2016
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Source: [NPI Profile](https://npiprofile.com/npi/1518300201) · Data from the CMS NPPES public registry.