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EVELYN BUTSOME SALLAH-KOOMSON APRN FNP-C
NPI 1245053966
Family Medicine in Herndon, VA

Active since November 01, 2024PECOS EnrolledAccepts Medicare Assignment
106 ELDEN ST STE 18B, HERNDON, VA 20170(703) 723-9100(703) 723-9200 Get Directions Write a Review

NPPES record last updated: November 1, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Evelyn Butsome Sallah-koomson Aprn Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVELYN BUTSOME SALLAH-KOOMSON APRN FNP-C (NPI 1245053966) is an individual family medicine provider in Herndon, Virginia, licensed in Virginia (0024191662) and active in the NPI registry since November 2024. The provider is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1245053966
Entity TypeIndividual
Primary Taxonomy207Q00000X
Provider Legal NameEVELYN BUTSOME SALLAH-KOOMSONCredential: APRN FNP-C
Location Address106 ELDEN ST STE 18BHerndon, VA 20170-4826
Mailing Address106 Elden St Ste 18bHerndon, VA 20170-4826 · (703) 723-9100 · Fax (703) 723-9200
Phone(703) 723-9100
Fax(703) 723-9200
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateNovember 1, 2024
NPPES CertifiedOctober 8, 2024
✔ NPI 1245053966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0024191662
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
106 ELDEN ST STE 18B, Herndon, VA 20170
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Evelyn Butsome Sallah-koomson Aprn Fnp-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618494824
PECOS Enrollment IDI20250509002198, I20251101000201
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Evelyn Sallah-koomson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Northstar Health Inc
7.8 mi
Internal Medicine
43109 UNISON KNOLL CIR
Ashburn, VA 20148
  • Reassigned Medicare billing, District of Columbia and Virginia enrollments
  • 5 clinicians in this Medicare group
NPI 1861094096 (702) 492-9439
Bon Secours Urgent Care LLC
90 mi
Urgent Care
9851 BROOK RD
Glen Allen, VA 23059
  • Reassigned Medicare billing, Virginia enrollment
  • 144 clinicians in this Medicare group
NPI 1265160501 (804) 893-8702

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20170 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GURMIT K MANN A-GNP-BC
Nurse Practitioner (Gerontology)
106 ELDEN ST STE 18B
HERNDON, VA 20170
Fairfax County (703) 723-9100
SIMONE PERRY
Nurse Practitioner (Family)
106 ELDEN ST STE 18B
HERNDON, VA 20170
Fairfax County (703) 723-9100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evelyn Sallah-koomson's NPI number?

The NPI number for Evelyn Sallah-koomson is 1245053966. It was assigned to this individual provider in the NPPES registry on November 1, 2024.

Where is Evelyn Sallah-koomson located?

Evelyn Sallah-koomson practices at 106 Elden St Ste 18B, Herndon, VA 20170. The listed phone number is (703) 723-9100.

What is Evelyn Sallah-koomson's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Evelyn Sallah-koomson enrolled in Medicare?

Yes. Evelyn Sallah-koomson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Evelyn Sallah-koomson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Evelyn Sallah-koomson reassigns Medicare benefits to 2 organizations: Northstar Health Inc (Ashburn, VA) and Bon Secours Urgent Care LLC (Glen Allen, VA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Evelyn Sallah-koomson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Evelyn Sallah-koomson was last updated on November 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.