Individual provider Active NPI

Mohammad Shahbaz Khan, MD

  • Surgery Physician
  • Cleburne, TX
National Provider Identifier
1063520062
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
Q1641 Issued in TX
Practice address
203 Walls Dr Ste 104
Cleburne, TX 76033-7022
Phone
(817) 556-5570
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Q1641 TX Primary

Addresses

Primary practice location

203 Walls Dr Ste 104
Cleburne, TX 76033-7022

Mailing address

203 Walls Dr Ste 104
Cleburne, TX 76033-7022
Phone (817) 556-5570

Other identifiers 1

IdentifierTypeStateIssuer
241533OtherNYLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070125000302 NY Practitioner - General Surgery 9335140888 Reassigns benefits to 1 organization
I20211122001387 TX Practitioner - General Surgery 9335140888 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
137433CAMDClinical Social Worker
Q1641TXMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Nov 1, 2021 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Surgery CurrentSince Sep 1, 2006 Accepting new patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group Surgery CurrentSince Nov 1, 2021 Accepting new patients

Locations

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

203 Walls Dr
Ste 203
Cleburne, TX 76033
Phone (817) 517-5756

203 Walls Dr
Ste 104
Cleburne, TX 76033
Phone (817) 556-5570

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1063520062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 WALLS DR STE 104",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760337022",
            "telephone_number": "817-556-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 WALLS DR STE 104",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760337022",
            "telephone_number": "817-556-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMAD",
        "middle_name": "SHAHBAZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "Q1641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "241533",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleburne, TX

Sources for this page

Verify at the official NPI Registry.