Active NPI
Fatima Khan, MD
- Hospitalist Physician
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 101132
- Practice address
- 3015 N Ballas Rd
Saint Louis, MO 63131-2329 - Phone
- (314) 996-5772
- NPI assigned
- Feb 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 101132 | MO | |
| Hospitalist Physician | 208M00000X | 101132 | MO | Primary |
Addresses
Primary practice location
3015 N Ballas Rd
Saint Louis, MO 63131-2329
Mailing address
3015 N Ballas Rd
Saint Louis, MO 63131-2329
Phone (314) 996-5772
Other practice location 1
12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 317-0600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 208661918 | Medicaid | MO | |
| 1083687669 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101132 | MO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Internal Medicine | Current | Accepting new patients |
| Physician Groups LC | Current | Accepting new patients | |
| Sound Physicians of Illinois, LLC | Internal Medicine | Current | Accepting new patients |
| Southeastern Physician Services PC | Internal Medicine | Current | Accepting new patients |
| Missouri Baptist Medical Center | Past | Accepting new patients |
Locations
12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360
2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454
6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442
3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330
10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522
Interoperability endpoints
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
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.
-
- Hospitalist Physician
- Bridgeton, MO
- NPI 1043598865
Internal Medicine
-
- Hospitalist Physician
- Oak Ridge, TN
- NPI 1083835441
Internal Medicine, MO
-
- Multi-Specialty Clinic/Center
- Farmington, MO
- NPI 1427114990
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1487663506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612224000000",
"number": "1083687669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3015 N BALLAS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631312329",
"telephone_number": "314-996-5772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3015 N BALLAS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631312329",
"telephone_number": "314-996-5772"
}
],
"practiceLocations": [
{
"address_1": "12303 De Paul Dr",
"address_purpose": "LOCATION",
"city": "Bridgeton",
"state": "MO",
"postal_code": "630442512",
"country_code": "US",
"telephone_number": "314-317-0600",
"fax_number": "314-317-0606",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KHAN",
"first_name": "FATIMA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-13",
"last_updated": "2021-02-02",
"certification_date": "2021-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "101132",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MO",
"license": "101132",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "208661918",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083687669",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3015 N Ballas Rd",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631312329",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.