Individual provider Active NPI

Nasiru Tejan

  • Family Nurse Practitioner
  • Alexandria, VA
National Provider Identifier
1720625221
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024178247 Issued in VA
Practice address
5402 Richenbacher Ave Apt 301
Alexandria, VA 22304-2053
Phone
(571) 489-3257
NPI assigned
Dec 3, 2019
Last updated
Nov 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024178247 VA Primary

Addresses

Primary practice location

5402 Richenbacher Ave Apt 301
Alexandria, VA 22304-2053

Mailing address

5402 Richenbacher Ave Apt 301
Alexandria, VA 22304-2053
Phone (571) 489-3257

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL ntejan12@su.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 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

Enrollment IDStateProvider typePAC IDDetails
I20200219000137 DC Practitioner - Nurse Practitioner 4486081197 Reassigns benefits to 2 organizations
I20200313001919 VA Practitioner - Nurse Practitioner 4486081197 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Century Dr
Apt 7306
Alexandria, VA 22304-7514
Phone (703) 740-3619

2109 Callao CT
Woodbridge, VA 22191-1480
Phone (703) 740-3619

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prestige Medical House Call LLC Single Specialty CurrentSince Jan 1, 2020 Accepting new patients
Starlink Medical House Call Single Specialty CurrentSince May 16, 2023 Accepting new patients
Pro Healthcare Servicing, LLC Past Accepting new patients
Pro Healthcare Servicing, LLC PastSince Jan 5, 2020 Accepting new patients

Locations

8315 Route 29
Ste 202
Fairfax, VA 22031
Phone (703) 352-1939

1320 Central Park Blvd
Ste 110
Fredericksburg, VA 22401
Phone (703) 352-1939

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1720625221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5402 RICHENBACHER AVE APT 301",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042053",
            "telephone_number": "571-489-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5402 RICHENBACHER AVE APT 301",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042053",
            "telephone_number": "571-489-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEJAN",
        "first_name": "NASIRU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-03",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024178247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "ntejan12@su.edu",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5402 Richenbacher Ave Apt 301",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223042053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

Verify at the official NPI Registry.