Individual provider Active NPI

Jennifer M Hickman, MD

  • Obstetrics & Gynecology Physician
  • Leesburg, VA
National Provider Identifier
1467581504
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
0101249492 Issued in VA
Practice address
163 Fort Evans Rd NE
Leesburg, VA 20176-4420
Phone
(703) 443-2000
NPI assigned
Mar 5, 2007
Last updated
Jul 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 121481 NC
Obstetrics & Gynecology Physician 207V00000X 0101249492 VA Primary

Addresses

Primary practice location

163 Fort Evans Rd NE
Leesburg, VA 20176-4420

Mailing address

163 Fort Evans Rd NE
Leesburg, VA 20176-4420

Other identifiers 1

IdentifierTypeStateIssuer
1467581504MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20110906000413 VA Practitioner - Obstetrics/Gynecology 5597831602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of South Carolina School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Loudoun Community Health CenterGroup PAC ID 5193822930, 11 clinicians

Practice addresses (Care Compare)

163 Fort Evans Rd NE
Leesburg, VA 20176-4420

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
121481NCMDObstetrics & Gynecology Physician
0101249492VAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Loudoun Community Health Center CurrentSince Oct 4, 2024 Accepting new patients
Loudoun Community Health Center CurrentSince Oct 4, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1141 Elden St
Ste 300
Herndon, VA 20170
Phone (703) 481-8160

13800 Wall Rd
Ste 55
Herndon, VA 20171

163 Fort Evans Rd NE
Leesburg, VA 20176
Phone (703) 433-2000

11484 Washington Plz W
Ste 300
Reston, VA 20190
Phone (703) 689-2180

21641 Ridgetop Cir
Ste 107
Sterling, VA 20166
Phone (703) 475-7595

Interoperability endpoints

  • Direct secure messaging: jennifer.hickman.1@12538.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1467581504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS RD NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 FORT EVANS RD NE",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201764420",
            "telephone_number": "703-443-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "121481",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101249492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467581504",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, VA

Sources for this page

Verify at the official NPI Registry.