Individual provider Active NPI

Nareesha Khan, MD

  • Internal Medicine Physician
  • Clearwater, FL
National Provider Identifier
1033405774
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME119066 Issued in FL
Practice address
855 S Highland Ave
Clearwater, FL 33756-4446
Phone
(727) 219-1833
Fax
(305) 698-6536
NPI assigned
Jun 21, 2011
Last updated
Oct 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME119066 FL Primary

Addresses

Primary practice location

855 S Highland Ave
Clearwater, FL 33756-4446

Mailing address

7050 Ulmerton Rd
Largo, FL 33771-5003
Phone (727) 777-4540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20141022001344 FL Practitioner - Internal Medicine 2163667098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Florida College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3128 E Hillsborough Ave
Chen Central FL Holdings
Tampa, FL 33610-4528
Phone (813) 579-1769

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME119066FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Feb 28, 2018 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Feb 28, 2018 Accepting new patients

Locations

855 S Highland Ave
Clearwater, FL 33756
Phone (727) 219-1833

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

7050 Ulmerton Rd
Largo, FL 33771
Phone (727) 777-4540

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

3128 E Hillsborough Ave
Tampa, FL 33610
Phone (813) 579-1767

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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.

NPI Registry JSON

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1033405774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7050 ULMERTON RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337715003",
            "telephone_number": "727-777-4540",
            "fax_number": "305-698-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S HIGHLAND AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337564446",
            "telephone_number": "727-219-1833",
            "fax_number": "305-698-6536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NAREESHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-21",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME119066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.