Individual provider Active NPI

Sidrah M Khan, FNP

  • Family Nurse Practitioner
  • Washington, DC
National Provider Identifier
1073280434
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F09210533 Issued in DC
Practice address
1920 L St NW Ste 350
Washington, DC 20036-5072
Phone
(916) 267-7947
Fax
(240) 403-7893
NPI assigned
Aug 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F09210533 VA
Family Nurse Practitioner 363LF0000X F09210533 DC Primary

Addresses

Primary practice location

1920 L St NW Ste 350
Washington, DC 20036-5072

Mailing address

1920 L St NW Ste 350
Washington, DC 20036-5072
Phone (202) 296-4002

Other practice location 1

75 W Lee Hwy
Warrenton, VA 20186-2149
Phone (540) 351-0662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220308000676 DC Practitioner - Nurse Practitioner 6002200011 Reassigns benefits to 1 organization
I20221024002351 VA Practitioner - Nurse Practitioner 6002200011 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F09210533DCMDFamily Nurse Practitioner
F09210533VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Jul 12, 2022 Accepting new patients
Privia Medical Group, LLC CurrentSince Jul 12, 2022 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

8644 Sudley Rd
#220
Manassas, VA 20110

75 W Lee Hwy
Warrenton, VA 20186
Phone (540) 347-4757

14900 Potomac Town Pl
Ste 110
Woodbridge, VA 22191
Phone (540) 351-0662

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1073280434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 L ST NW STE 350",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200365072",
            "telephone_number": "202-296-4002",
            "fax_number": "240-403-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 L ST NW STE 350",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200365072",
            "telephone_number": "916-267-7947",
            "fax_number": "240-403-7893"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 W Lee Hwy",
            "address_purpose": "LOCATION",
            "city": "Warrenton",
            "state": "VA",
            "postal_code": "201862149",
            "country_code": "US",
            "telephone_number": "540-351-0662",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SIDRAH",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "F09210533",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DC",
            "license": "F09210533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.