NPIMap

Organization Active NPI

Neighborhood Health

Doing business as Annandale Medical

  • Federally Qualified Health Center (FQHC)
  • Annandale, VA
National Provider Identifier
1093486680
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTH
Doing business as
Annandale Medical
Practice address
6715 Little River Tpke Ste 201
Annandale, VA 22003-3546
Phone
(703) 535-5568
NPI assigned
Sep 23, 2021
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Basim Khan, MDNPI 1477880045
Title
Ceo
Phone
(703) 535-5568

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

6715 Little River Tpke Ste 201
Annandale, VA 22003-3546

Mailing address

6677 Richmond Hwy
Alexandria, VA 22306-6647
Phone (703) 535-5568

Other names 1

  • Annandale Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040707000325 DC Part B Supplier - Clinic/Group Practice 7517853419 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, VA; Annandale, VA; Alexandria, VA
O20211201002077 VA Part A Provider - Federally Qualified Health Center (FQHC) 7517853419 Practice locations: Annandale, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093486680. Details of each certification follow.

Federally qualified health center certification: CCN 491983

Legal name
NEIGHBORHOOD HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2021
Last certification
Dec 1, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1997 in VA
Enrollment address
6715 Little River Tpke
Ste 201
Annandale, VA 22003-3546

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2252182Neighborhood Health Annandale Medical6715 Little River Turnpike Suite 201, Annandale, VA 22003Provider-performed microscopyFeb 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Neighborhood Health23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alisa Whyte Individual Corporate Director Sep 18, 2017
Miriam Aguila Individual Corporate Director Jul 1, 2019
Nora Partlow Individual Corporate Director Jan 1, 2020
Basim N Khan Individual Corporate DirectorCeo Sep 17, 2014
W-2 Managing EmployeeCeo Sep 17, 2014
Michael Millman Individual Corporate Director Mar 30, 2015
Carter Flemming Individual Corporate Director Jul 1, 2019
Muhammad Arif Individual Corporate Director Jan 1, 2019
Richard Gundling Individual Corporate DirectorTreasurer Jan 1, 2015
Elhafedh Talebimijine Individual Corporate Director Jul 1, 2019
Paola Navarro Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1093486680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 RICHMOND HWY",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223066647",
            "telephone_number": "703-535-5568",
            "fax_number": "703-299-1794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6715 LITTLE RIVER TPKE STE 201",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033546",
            "telephone_number": "703-535-5568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "BASIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-535-5568",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Annandale Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Annandale, VA

Sources for this page

Verify at the official NPI Registry.