Sam Kidane

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

LG-0011831 Issued in DE

Practice address

314 E Main St Ste 103
Newark, DE 19711-7180

Phone

(302) 366-0550

NPI assigned

Nov 26, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DE, VA, DC3 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 3

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Inova Ucc LLCGroup PAC ID 7012385040, 158 clinicians

Virginia Urgent Care LLCGroup PAC ID 2062572456, 24 clinicians

Manbir Takhar PCGroup PAC ID 0749206951, 41 clinicians

Tru Health Group PCGroup PAC ID 6406216183, 29 clinicians

Medical Access PCGroup PAC ID 9335405844, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Northern Virginia Medical Center Hospital, Woodbridge, VA, CCN 490113

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sam.kidane.2@20907.direct.athenahealth.com

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.

• Inova Ucc LLC

  • Urgent Care Clinic/Center
  • Vienna, VA
  • NPI 1508592114

  DC

  Medicare reassignment Care Compare group NPD
• Manbir Takhar, P.C.

  • Primary Care Clinic/Center
  • Germantown, MD
  • NPI 1457322505

  DC, VA

  Medicare reassignment Care Compare group NPD
• Medical Access P.C.

  • Urgent Care Clinic/Center
  • Germantown, MD
  • NPI 1144291204

  DC, VA

  Medicare reassignment Care Compare group NPD
• Tru Health Group, PC

  • Urgent Care Clinic/Center
  • Germantown, MD
  • NPI 1194471946

  DC, VA

  Medicare reassignment Care Compare group NPD
• Virginia Urgent Care LLC

  • Urgent Care Clinic/Center
  • Fredericksburg, VA
  • NPI 1487838652
  Medicare reassignment Care Compare group NPD
• Premiere Physicians P.a.

  • Internal Medicine Physician
  • Newark, DE
  • NPI 1760580336
  Medicare reassignment NPD
• Complete Sleep Lab Inc

  • Clinic/Center
  • Newark, DE
  • NPI 1457841421
  NPD
• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440
  NPD (past)

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

• Potomac Hospital Corporation of Prince William

  • General Acute Care Hospital
  • Woodbridge, VA
  • NPI 1548366404
  Care Compare affiliation

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

{
    "created_epoch": "1637884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1497412399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 GREEN ST",
            "city": "CLAYMONT",
            "state": "DE",
            "postal_code": "197032054",
            "telephone_number": "302-299-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 E MAIN ST STE 103",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197117180",
            "telephone_number": "302-366-0550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 White Oak Rd",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224052792",
            "country_code": "US",
            "telephone_number": "540-373-2424",
            "fax_number": "540-373-3258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDANE",
        "first_name": "SAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-26",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024188207",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0011831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "eClincalWorks",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "314 E Main St Ste 103",
            "city": "Newark",
            "state": "DE",
            "country_code": "US",
            "postal_code": "197117180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamil Khatri, M.D.
• Yasmin Khattab
• Rahil Kheirkhah, DO, PHD
• Swapnil Dadasaheb Khose, MBBS
• Layla Kidane
• Elise Kidd
• Kidney Care Associates PA
• Jennifer Kielhorn, PA-C
• Julie Anne Kieliszak, CRNP
• Ann Kim, MD

• Family Nurse Practitioner in Newark, DE
• Providers in Newark, DE by specialty
• Family Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.