Evelyn Butsome Sallah-Koomson, APRN FNP-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0024191662 Issued in VA

Practice address

106 Elden St Ste 18B
Herndon, VA 20170-4826

Phone

(703) 723-9100

Fax

(703) 723-9200

NPI assigned

Nov 1, 2024

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northstar Health IncGroup PAC ID 5496168320, 5 clinicians

Bon Secours Urgent Care LLCGroup PAC ID 6709256142, 125 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23503/brand/1/csg/1/fhir/r4

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.

• Bon Secours Urgent Care LLC

  • Urgent Care Clinic/Center
  • Glen Allen, VA
  • NPI 1265160501

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Northstar Health Inc

  • Internal Medicine Physician
  • Ashburn, VA
  • NPI 1861094096

  DC, Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Northstar Health Inc

  • Internal Medicine Physician
  • Dulles, VA
  • NPI 1487222451
  NPD (past)
• Icare Mobile Wound Care VA PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Miami, FL
  • NPI 1932992856

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1730419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1245053966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 ELDEN ST STE 18B",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704826",
            "telephone_number": "703-723-9100",
            "fax_number": "703-723-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 ELDEN ST STE 18B",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704826",
            "telephone_number": "703-723-9100",
            "fax_number": "703-723-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLAH-KOOMSON",
        "first_name": "EVELYN",
        "middle_name": "BUTSOME",
        "credential": "APRN FNP-C",
        "sole_proprietor": "YES",
        "sex": "U",
        "enumeration_date": "2024-11-01",
        "last_updated": "2024-11-01",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0024191662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zahra Saemi
• Elham Safari, D.D.S.
• Perla Saliba, FNP
• Lamieh Salimi, LPC
• Kamran Hussainzadah Saljuki, PHARMD
• Andrea Sanabria
• Ileana Sanchez Vanquez, O.T.
• Christine Michele Sanchez, CC-AASP
• Sandeep Kaur, DDS, PC
• Isata Sankoh, CNA

• Family Medicine Physician in Herndon, VA
• Providers in Herndon, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.

Verify at the official NPI Registry.