Individual provider Active NPI

Khaled Adam Anees, M.D.

  • Neurology Physician
  • Tustin, CA
National Provider Identifier
1053587451
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A118645 Issued in CA
Practice address
13217 Jamboree Rd Ste 301
Tustin, CA 92782-9158
Phone
(949) 333-9000
NPI assigned
May 6, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301111674 MI
Neurology Physician 2084N0400X 62835-20 WI
Neurology Physician 2084N0400X 036152718 IL
Neurology Physician 2084N0400X DR.0059263 CO
Neurology Physician 2084N0400X 25MA09954300 NJ
Neurology Physician 2084N0400X A118645 CA Primary

Addresses

Primary practice location

13217 Jamboree Rd Ste 301
Tustin, CA 92782-9158

Mailing address

12195 Wyne CT
Tustin, CA 92782-1185
Phone (949) 333-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20171011003628 CO Practitioner - Neurology 0749333540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A118645CAMDNeurology Physician
036152718ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

1619 N Greenwood St
Ste 210
Pueblo, CO 81003
Phone (719) 542-5121

1619 N Greenwood St
Ste 402
Pueblo, CO 81003
Phone (719) 562-2030

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

1619 N Greenwood St
Ste 200
Pueblo, CO 81003
Phone (719) 543-1130

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1053587451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12195 WYNE CT",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927821185",
            "telephone_number": "949-333-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13217 JAMBOREE RD STE 301",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927829158",
            "telephone_number": "949-333-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANEES",
        "first_name": "KHALED",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-06",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301111674",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "62835-20",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036152718",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CO",
            "license": "DR.0059263",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NJ",
            "license": "25MA09954300",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A118645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.