NPIMap

Organization Active NPI

Internal Medicine Spec of Southern NV Grossman Panikkar Ghadishah Whi

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1013917640
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE SPEC OF SOUTHERN NV GROSSMAN PANIKKAR GHADISHAH WHI
Practice address
201 N Buffalo Dr
Las Vegas, NV 89145-0373
Phone
(702) 242-2737
Fax
(702) 255-3170
NPI assigned
Jul 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Authorized official

Name
Babak Ghadishah, DONPI 1346272408
Title
President
Phone
(702) 242-2737

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

201 N Buffalo Dr
Las Vegas, NV 89145-0373

Mailing address

201 N Buffalo Dr
Las Vegas, NV 89145-0373
Phone (702) 242-2737

Other identifiers 1

IdentifierTypeStateIssuer
100501810MedicaidNV

Other names 1

  • INTERNAL MEDICINE SPECIALISTS OF SOUTHERN NEVADA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000718 NV Part B Supplier - Clinic/Group Practice 6507854049 Receives reassigned benefits from 12 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

201 N Buffalo Dr
Las Vegas, NV 89145
Phone (702) 242-2737

9895 S Maryland Pkwy
Ste A
Las Vegas, NV 89183
Phone (702) 372-4039

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1013917640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N BUFFALO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891450373",
            "telephone_number": "702-242-2737",
            "fax_number": "702-255-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N BUFFALO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891450373",
            "telephone_number": "702-242-2737",
            "fax_number": "702-255-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE SPEC OF SOUTHERN NV GROSSMAN PANIKKAR GHADISHAH WHI",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "GHADISHAH",
        "authorized_official_first_name": "BABAK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-242-2737",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100501810",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTERNAL MEDICINE SPECIALISTS OF SOUTHERN NEVADA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INTERNAL MEDICINE SPECIALISTS OF SOUTHERN NEVADA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.