Individual provider Active NPI

Irtiah Khan, PA-C

  • Physician Assistant
  • Warren, MI
National Provider Identifier
1073259149
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011120 Issued in MI
Practice address
31150 Hoover Rd Ste B
Warren, MI 48093-7618
Phone
(586) 983-3666
NPI assigned
May 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601011120 MI Primary

Addresses

Primary practice location

31150 Hoover Rd Ste B
Warren, MI 48093-7618

Mailing address

31150 Hoover Rd Ste B
Warren, MI 48093-7618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251204001474 NY Practitioner - Physician Assistant 7012400351 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

5100 W Taft Rd
Liverpool, NY 13088-4841

7250 Janus Park Dr
Liverpool, NY 13088-4839
Phone (315) 475-8402

Hospital & facility affiliations

  • St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
033879NYMDDentist
5601011120MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
BG Tricounty Neurology& Sleep Clinic PC CurrentSince May 16, 2022 Accepting new patients
St Josephs Hospital Health Center CurrentSince Dec 1, 2025 Accepting new patients
St Josephs Medical PC CurrentSince Dec 1, 2025 Accepting new patients
St. Joseph'S Pathology, PC Current Accepting new patients
St Joseph'S Hospital Health Center CurrentSince Dec 1, 2025 Accepting new patients
North Medical PC Current Accepting new patients
Pulmonary Health Physicians PC Past Accepting new patients

Locations

31150 Hoover Rd
Ste B
Warren, MI 48093
Phone (586) 983-3666

7250 Janus Park Dr
Liverpool, NY 13088
Phone (315) 475-8402

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

Organizations & group practices 7

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 1

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": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1073259149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31150 HOOVER RD STE B",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31150 HOOVER RD STE B",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937618",
            "telephone_number": "586-983-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "IRTIAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.