Active NPI
Ali Khavari, M.D.
- Urology Physician
- Bangor, ME
National Provider Identifier
1013913433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 009535
- Practice address
- 55 Broadway
Suite 2
Bangor, ME 04401-5201 - Phone
- (207) 973-8881
- Fax
- (207) 947-5368
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 009535 | ME | Primary |
Addresses
Primary practice location
55 Broadway
Suite 2
Bangor, ME 04401-5201
Mailing address
43 Whiting Hill Rd
Brewer, ME 04412-1005
Phone (207) 973-8881
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110720099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009535 | ME | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Maine Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Rehabilitation Hospital Unit
- Bangor, ME
- NPI 1780674689
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393545600000",
"number": "1013913433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 WHITING HILL RD",
"city": "BREWER",
"state": "ME",
"postal_code": "044121005",
"telephone_number": "207-973-8881",
"fax_number": "207-973-8880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 BROADWAY",
"address_2": "SUITE 2",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015201",
"telephone_number": "207-973-8881",
"fax_number": "207-947-5368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAVARI",
"first_name": "ALI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2014-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "ME",
"license": "009535",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110720099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.