Individual provider Active NPI

Sandor Shawn Niemann, MD

  • Family Medicine Physician
  • Centreville, VA
National Provider Identifier
1861484461
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101050091 Issued in VA
Practice address
5645 Stone Rd
Centreville, VA 20120-1618
Phone
(703) 266-2442
Fax
(703) 266-7158
NPI assigned
Aug 19, 2005
Last updated
Mar 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101050091 VA Primary

Addresses

Primary practice location

5645 Stone Rd
Centreville, VA 20120-1618

Mailing address

5645 Stone Rd
Centreville, VA 20120-1618
Phone (703) 266-2442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20170621001961 DC Practitioner - Family Practice 5092083766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Uniformed Services Uhs Fe Hebert School of Med, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rocky Run Family Medicine IncGroup PAC ID 5193624773, 7 clinicians

Practice addresses (Care Compare)

5645 Stone Rd
Centreville, VA 20120-1618
Phone (703) 266-2442

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Run Family Medicine Inc CurrentSince Jun 19, 2017 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5645 Stone Rd
Centreville, VA 20120
Phone (703) 266-2442

Organizations & group practices 2

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 1

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1861484461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 STONE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201201618",
            "telephone_number": "703-266-2442",
            "fax_number": "703-266-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 STONE RD",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201201618",
            "telephone_number": "703-266-2442",
            "fax_number": "703-266-7158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEMANN",
        "first_name": "SANDOR",
        "middle_name": "SHAWN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101050091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, VA

Sources for this page

Verify at the official NPI Registry.