Individual provider Active NPI

Annick Stam-Cheatham, MD

  • Family Medicine Physician
  • Reston, VA
National Provider Identifier
1154482685
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101239148 Issued in VA
Practice address
11930 Democracy Dr
Reston, VA 20190-5624
Phone
(888) 663-6331
Fax
(415) 252-7176
NPI assigned
Dec 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101239148 VA Primary
Family Medicine Physician 207Q00000X K0560 TX

Addresses

Primary practice location

11930 Democracy Dr
Reston, VA 20190-5624

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Phone (415) 658-6791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051206000755 DC Practitioner - Family Practice 5294755104 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at Houston, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
One Medstar Primary Care LLCGroup PAC ID 0749607307, 140 clinicians

Practice addresses (Care Compare)

1001 G St NW
Suite 200E
Washington, DC 20001-4546
Phone (202) 660-0005

11930 Democracy Dr
Reston, VA 20190-5624
Phone (888) 663-6331

601 New Jersey Ave NW
Suite 200
Washington, DC 20001-3030
Phone (202) 660-0005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101239148VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Aug 4, 2017 Accepting new patients
Privia Medical Group, LLC Family Medicine CurrentSince Aug 4, 2017 Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

7617 Little River Tpke
Ste 710
Annandale, VA 22003
Phone (703) 642-0094

950 N Glebe Rd
Ste 4000
Arlington, VA 22203
Phone (301) 593-9011

9409B Old Burke Lake Rd
Burke, VA 22015
Phone (703) 978-4200

Organizations & group practices 3

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1154482685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723",
            "telephone_number": "415-658-6791",
            "fax_number": "415-252-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 DEMOCRACY DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905624",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAM-CHEATHAM",
        "first_name": "ANNICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101239148",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K0560",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.