NPIMap

Organization Active NPI

Evergreen Neurology and Sleep Center

  • Neurology Physician
  • Manassas, VA
National Provider Identifier
1750870556
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
0101260753 Issued in VA
Legal business name
EVERGREEN NEUROLOGY AND SLEEP CENTER
Practice address
8609 Sudley Rd Ste 204
Manassas, VA 20110-4500
Phone
(703) 348-7207
Fax
(703) 435-1844
NPI assigned
May 7, 2018
Last updated
May 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Authorized official

Name
Dr. Ishtiaq Ahmad, MDNPI 1326008384
Title
Ceo
Phone
(703) 389-9712

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 0101260753 VA Primary

Addresses

Primary practice location

8609 Sudley Rd Ste 204
Manassas, VA 20110-4500

Mailing address

8609 Sudley Rd Ste 204
Manassas, VA 20110-4500
Phone (703) 348-7207

Other practice location 1

1860 Town Center Dr Ste 320
Reston, VA 20190-5899
Phone (703) 348-7207

National Provider Directory

National Provider Directory

Locations

8609 Sudley Rd
Ste 204
Manassas, VA 20110
Phone (703) 239-3602

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17907/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1750870556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 SUDLEY RD STE 204",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104500",
            "telephone_number": "703-348-7207",
            "fax_number": "703-435-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8609 SUDLEY RD STE 204",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104500",
            "telephone_number": "703-348-7207",
            "fax_number": "703-435-1844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1860 Town Center Dr Ste 320",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201905899",
            "country_code": "US",
            "telephone_number": "703-348-7207",
            "fax_number": "703-435-1844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN NEUROLOGY AND SLEEP CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "ISHTIAQ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-389-9712",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101260753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.