NPIMap

Individual provider Active NPI

Shakaib Naseem Khan, M.D.

  • Psychiatry Physician
  • Farmington, CT
National Provider Identifier
1134561335
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
56182 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-6410
Phone
(860) 679-6700
NPI assigned
Jul 29, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 56182 CT Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-6410

Mailing address

263 Farmington Ave
Farmington, CT 06030-6410
Phone (860) 679-6700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address akhan11285@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20180402002019 CT Practitioner - Psychiatry 4880956812 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of ConnecticutGroup PAC ID 8022915677, 267 clinicians

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Windham Community Memorial Hospital, Inc. CurrentSince May 1, 2018 Accepting new patients
State of Connecticut CurrentSince Apr 21, 2021 Accepting new patients
William W Backus Hospital CurrentSince May 4, 2018 Accepting new patients
Natchaug Hospital, Inc. CurrentSince Jun 24, 2018 Accepting new patients
The William W Backus Hospital CurrentSince May 4, 2018 Accepting new patients
University of Connecticut Health Center CurrentSince Apr 21, 2021 Accepting new patients
University of Connecticut Health Center CurrentSince Apr 21, 2021 Accepting new patients
State of Connecticut CurrentSince Apr 21, 2021 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

263 Farmington Ave
Farmington, CT 06032
Phone (860) 679-1706

189 Storrs Rd
Mansfield Ctr, CT 06250
Phone (860) 456-1311

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

Interoperability endpoints

  • Direct secure messaging: akhan11285@direct.med.uchc.edu

Organizations & group practices 9

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 2

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": "1375056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1134561335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060306410",
            "telephone_number": "860-679-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060306410",
            "telephone_number": "860-679-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SHAKAIB",
        "middle_name": "NASEEM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-29",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "56182",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "akhan11285@direct.med.uchc.edu",
            "affiliation": "N",
            "endpointDescription": "UConn",
            "address_1": "263 Farmington Ave",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060306410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.