Elaheh Bani Ahmad
Individual provider Active NPI Nurse Practitioner · Moseley, VA
NPI 1265059760 · NPPES record last updated Jun 30, 2020
Key facts
- NPI
- 1265059760
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 0024179498 (VA)
- Practice address
- 8425 Hampton Farms Dr
Moseley, VA 23120-1713 - Phone
- (180) 493-3287
- NPI assigned
- Jun 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Colonial Kidneycare Specialists, PC
Practice addresses (Care Compare)
3601 Boulevard
Suite C
Colonial Heights, VA 23834-1338
Phone (804) 504-0068
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220512002652 | VA | Practitioner - Nurse Practitioner | 5597142505 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024179498 | VA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Colonial Kidney Specialists PLLC | Current |
Accepting new patients | |
| Colonial Kidneycare Specialists, PC | Current |
Accepting new patients |
Locations
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
3601 Boulevard
Ste C
Colonial Hgts, VA 23834
Phone (804) 504-0068
1806 Summit Ave
Richmond, VA 23230
Phone (213) 433-2823
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 0024179498 | VA | Yes |
Addresses
Primary practice location
8425 Hampton Farms Dr
Moseley, VA 23120-1713
Mailing address
8425 Hampton Farms Dr
Moseley, VA 23120-1713
Phone (180) 493-3287
Other providers in Moseley, VA
- Ahadu Transportation LLC
- Michelle C Aiello
- All in a Day Transportation LLC
- Candice M Arnold
- Nikia Bailey
- Cassondra Blackstock
- Philippe Marie Blot
- Brighter Outcomes Family Services
- Maeve Bryant
- Bunns Consulting LLC
All providers in Moseley, VA · Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.