NPIMap

Individual provider Active NPI

Nimra Khan

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1073926838
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME130471 Issued in FL
Practice address
2377 Dunn Ave
Jacksonville, FL 32218-6983
Phone
(904) 633-0700
NPI assigned
Jun 9, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME130471 FL Primary

Addresses

Primary practice location

2377 Dunn Ave
Jacksonville, FL 32218-6983

Mailing address

2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372

Other practice location 1

2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201216000583 NC Practitioner - Family Practice 3375822869 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Brody School of Medicine at East Carolina University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

5716 Fayetteville Rd
Durham, NC 27713-9661
Phone (919) 572-1868

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME130471FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Health System, Inc. Current Accepting new patients
Duke University Health System, Inc. CurrentSince Nov 14, 2024 Accepting new patients
Duke University Health System, Inc. Family Medicine CurrentSince Nov 14, 2024 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Nov 9, 2020 Accepting new patients
Duke Health Integrated Practice, Inc. Past Accepting new patients

Locations

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

5716 Fayetteville Rd
Durham, NC 27713
Phone (919) 572-1868

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

11635 Northpark Dr
Ste 200
Wake Forest, NC 27587
Phone (919) 535-4879

Interoperability endpoints

  • Direct secure messaging: nknan473575@direct.medicine.duke.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1402272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073926838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-308-7372",
            "fax_number": "904-308-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2377 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322186983",
            "telephone_number": "904-633-0700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2627 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044712",
            "country_code": "US",
            "telephone_number": "904-308-7372",
            "fax_number": "904-308-2908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NIMRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME130471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.