NPIMap

Individual provider Active NPI

Khurram A Khan, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Stone Mountain, GA
National Provider Identifier
1063677011
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
067490 Issued in GA
Practice address
500 Springhouse Cir
Stone Mountain, GA 30087-6741
Phone
(770) 879-4330
Fax
(678) 684-3066
NPI assigned
Jul 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 067490 GA
Geriatric Medicine (Family Medicine) Physician 207QG0300X 067490 GA Primary

Addresses

Primary practice location

500 Springhouse Cir
Stone Mountain, GA 30087-6741

Mailing address

954 Woodward Park Dr
Suwanee, GA 30024-2859
Phone (678) 665-5370

Other practice location 1

1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120717000058 GA Practitioner - Family PracticePractitioner - Geriatric MedicinePractitioner - Emergency Medicine 6204092455 Reassigns benefits to 6 organizations
I20250123001705 GA Practitioner - Hospitalist 6204092455 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PT Hills Place Terraces LLCGroup PAC ID 5597196436, 2 clinicians
Vituity-Georgia Hospitalists PCGroup PAC ID 4789124496, 15 clinicians
Park Springs LLCGroup PAC ID 7810961380, 4 clinicians

Practice addresses (Care Compare)

229 Peachtree Hills Ave NE
Atlanta, GA 30305-4411
Phone (678) 619-3219

367 Clear Creek Pkwy
Lavonia, GA 30553-4173
Phone (706) 356-7800

500 Springhouse Cir
Stone Mountain, GA 30087-6741
Phone (770) 879-4330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
067490GAMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PT Hills Place Terraces LLC CurrentSince Sep 15, 2022 Accepting new patients
Park Springs, LLC CurrentSince Nov 1, 2018 Accepting new patients
Vituity-Georgia Hospitalists PC Hospitalist CurrentSince Dec 27, 2024 Accepting new patients
Park Springs, LLC CurrentSince Nov 1, 2018 Accepting new patients
The Emory Clinic Inc Geriatric Medicine CurrentSince Oct 1, 2012 Accepting new patients
Georgia Emergency Group, LLC CurrentSince Apr 16, 2016 Accepting new patients
PT Hills Place Terraces LLC CurrentSince Sep 15, 2022 Accepting new patients
Cogent Healthcare of Georgia PC Hospitalist CurrentSince May 17, 2017 Accepting new patients
Nes of Florida, Inc. Past Accepting new patients
St. Mary's Sacred Heart Hospital, Inc. Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

1050 McDonough Rd
Jackson, GA 30233
Phone (770) 775-7861

367 Clear Creek Pkwy
Lavonia, GA 30553
Phone (706) 356-7800

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

5610 New Bermuda Rd
Stone Mountain, GA 30087
Phone (678) 384-3872

500 Springhouse Cir
Stone Mtn, GA 30087
Phone (678) 684-3800

Interoperability endpoints

  • Direct secure messaging: kkhan2205765@direct.trinity-health.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/EHDEDD/Endpoint/EHDEDD
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pebblebrook Health Center at Park SpringsStone Mountain, GA, CCN 115694 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2022
Jun 2, 2025
The Terraces at Peachtree Hills PlaceAtlanta, GA, CCN 115773 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
May 6, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Park Springs, LLC

    dba Pebblebrook Health Center at Park Springs

    • Skilled Nursing Facility
    • Stone Mountain, GA
    • NPI 1184605693

    Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • PT Hills Place Terraces LLC

    dba The Terraces at Peachtree Hills Place

    • Skilled Nursing Facility
    • Atlanta, GA
    • NPI 1881222701

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 10

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 10

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": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1063677011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 WOODWARD PARK DR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242859",
            "telephone_number": "678-665-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SPRINGHOUSE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876741",
            "telephone_number": "770-879-4330",
            "fax_number": "678-684-3066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1821 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303294021",
            "country_code": "US",
            "telephone_number": "404-728-6363",
            "fax_number": "404-728-6298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "KHURRAM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "067490",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "GA",
            "license": "067490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

Verify at the official NPI Registry.