Active NPI
Khanh Q Nguyen, PA C
- Physician Assistant
- Orlando, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9102312
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| U1470Y | Other | FL | MEDICARE PTAN - QSS SCS |
| 291549900 | Medicaid | FL | |
| HF826A | Other | FL | MEDICARE 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
Enrollment records 1
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
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005821 | NY | MD | Mental Health Counselor |
| PA9102312 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Hospital Medical Group Inc | Physician Assistant | Current | Accepting new patients |
| Florida Hospital Medical Group Inc | Current | Accepting new patients | |
| Southeastern Clinical Services,Inc. | Surgical | Past | 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
- 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.
-
- Family Medicine Physician
- Orlando, FL
- NPI 1225034234
Physician Assistant
-
- Prosthetic/Orthotic Supplier
- Minneola, FL
- NPI 1285591545
-
- Surgical Physician Assistant
- Orlando, FL
- NPI 1033162011
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Orlando, FL
- NPI 1306938071
-
- Clinical Medical Laboratory
- Orlando, FL
- NPI 1801569728
Hospital
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.