NPIMap

Individual provider Active NPI

Imad Khdair, MD

  • Internal Medicine Physician
  • Sylacauga, AL
National Provider Identifier
1093725624
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28198 Issued in KY
Practice address
209 W Spring St
Suite 200
Sylacauga, AL 35150-2973
Phone
(256) 245-5241
Fax
(256) 245-0194
NPI assigned
Aug 8, 2006
Last updated
Oct 17, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28198 KY Primary
Internal Medicine Physician 207R00000X 30074 AL

Addresses

Primary practice location

209 W Spring St
Suite 200
Sylacauga, AL 35150-2973

Mailing address

1816 Summit PL
Birmingham, AL 35243-3141

Other identifiers 2

IdentifierTypeStateIssuer
64281983MedicaidKY
120103MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20100920000143 AL Practitioner - Internal Medicine 4284759812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Craddock Health Center P CGroup PAC ID 9032135504, 4 clinicians

Practice addresses (Care Compare)

209 W Spring St
Suite 200
Sylacauga, AL 35150-2975
Phone (256) 245-5241

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30074ALMDInternal Medicine Physician
28198KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Quality of Life Health Services, Inc Current Accepting new patients
Quality of Life Health Services, Inc Current Accepting new patients
Sylacauga Health Care Authority Inc Past Accepting new patients

Locations

1411 Piedmont Cutoff
Gadsden, AL 35903
Phone (205) 492-0131

Interoperability endpoints

  • Direct secure messaging: imad.khdair@chc.direct.medconnecthealth.com
  • Direct secure messaging: imad.khdair@cradcent.direct.medconnect-inc.com

Organizations & group practices 4

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 6

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1093725624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 SUMMIT PL",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352433141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W SPRING ST",
            "address_2": "SUITE 200",
            "city": "SYLACAUGA",
            "state": "AL",
            "postal_code": "351502973",
            "telephone_number": "256-245-5241",
            "fax_number": "256-245-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHDAIR",
        "first_name": "IMAD",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "28198",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "30074",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64281983",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120103",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylacauga, AL

Sources for this page

Verify at the official NPI Registry.