Individual provider Active NPI

Khanh Q Nguyen, PA C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1164417010
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9102312 Issued in FL
Practice address
601 E Rollins St
Orlando, FL 32803-1248
Phone
(407) 609-0095
Fax
(407) 609-0096
NPI assigned
Sep 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9102312 FL
Physician Assistant 363A00000X PA9102312 FL Primary

Addresses

Primary practice location

601 E Rollins St
Orlando, FL 32803-1248

Mailing address

PO Box 4059
Wayne, NJ 07474-4059
Phone (973) 826-8291

Other practice location 1

4215 Edgewater Dr
Orlando, FL 32804-2206
Phone (407) 539-2000

Other identifiers 3

IdentifierTypeStateIssuer
U1470YOtherFLMEDICARE PTAN - QSS SCS
291549900MedicaidFL
HF826AOtherFLMEDICARE PTAN - GRP QSS SCS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110407000372 FL Practitioner - Physician Assistant 0143404640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
JS Weill Medical College, Cornell University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2000 Fowler Grove Blvd
Winter Garden, FL 34787-5050

2501 N Orange Ave
Orlando, FL 32804-4641

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

400 Celebration PL
Celebration, FL 34747-4970

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-2570

631 E Altamonte Dr
Suite 231
Altamonte Springs, FL 32701-4802
Phone (407) 303-5214

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
005821NYMDMental Health Counselor
PA9102312FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince May 31, 2024 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince May 31, 2024 Accepting new patients
Southeastern Clinical Services,Inc. Surgical PastSince Jun 5, 2012 Accepting new patients

Locations

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: knguyen129322@adventhealth.direct-ci.com

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1164417010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4059",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074744059",
            "telephone_number": "973-826-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-609-0095",
            "fax_number": "407-609-0096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4215 Edgewater Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328042206",
            "country_code": "US",
            "telephone_number": "407-539-2000",
            "fax_number": "407-398-0050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KHANH",
        "middle_name": "Q",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9102312",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN - QSS SCS",
            "identifier": "U1470Y",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291549900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN - GRP QSS SCS",
            "identifier": "HF826A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.