Individual provider Active NPI

Sameeha Khalid, DO

  • Gastroenterology Physician
  • Mesa, AZ
National Provider Identifier
1114489705
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
010151 Issued in AZ
Practice address
1301 S Crismon Rd
Mesa, AZ 85209-3767
Phone
(480) 358-6100
NPI assigned
Apr 2, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 010151 AZ Primary
Internal Medicine Physician 207R00000X 20A19746 CA

Addresses

Primary practice location

1301 S Crismon Rd
Mesa, AZ 85209-3767

Mailing address

1301 S Crismon Rd
Mesa, AZ 85209-3767
Phone (559) 499-6500

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220824002944 CA Practitioner - Internal Medicine 7012391006 Reassigns benefits to 1 organization
I20260217003767 AZ Practitioner - Internal Medicine 7012391006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

25702 S Greenway Dr
Claremore, OK 74019-2381

PO Box
Suite 51270
Mesa, AZ 85208

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A19746CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mulberry Medical LLC CurrentSince Jan 15, 2026 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 13, 2022 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 13, 2022 Accepting new patients
Plastic and Peripheral Nerve Surgery LLC PastSince Jan 15, 2026 Accepting new patients

Locations

5801 S McClintock Dr
Ste 104
Tempe, AZ 85283
Phone (623) 220-2601

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AHHIDD

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1114489705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 S CRISMON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093767",
            "telephone_number": "559-499-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S CRISMON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852093767",
            "telephone_number": "480-358-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALID",
        "first_name": "SAMEEHA",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "010151",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A19746",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.