NPIMap

Individual provider Active NPI

Khawaja Hasham Faisal, MD

  • Hospitalist Physician
  • Providence, RI
National Provider Identifier
1154843332
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD16966 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-3985
NPI assigned
Jul 10, 2017
Reactivated
Mar 6, 2018
Last updated
Jun 25, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Hospitalist Physician 208M00000X MD16966 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

117 Ellenfiled Street
Suite 101
Providence, RI 02905-4513
Phone (401) 444-6779

Other practice location 1

825 Chalkstone Avenue
Providence, RI 02908-4735
Phone (401) 456-2033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200724000399 RI Practitioner - Hospitalist 6406111830 Reassigns benefits to 1 organization
I20240712000201 MA Practitioner - Internal Medicine 6406111830 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jul 1, 2024 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jul 1, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Jul 1, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Jul 1, 2024 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Past Accepting new patients
Beth Israel Deaconess Hospital Plymouth, Inc. Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

199 Reedsdale Rd
Milton, MA 02186
Phone (617) 313-1000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Providence, RI 02903

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

Interoperability endpoints

  • Direct secure messaging: khawaja.faisal.2@9000.direct.athenahealth.com

Organizations & group practices 8

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 4

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": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1154843332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFILED STREET",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-3985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "825 Chalkstone Avenue",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029084735",
            "country_code": "US",
            "telephone_number": "401-456-2033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAISAL",
        "first_name": "KHAWAJA",
        "middle_name": "HASHAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-10",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "deactivation_date": "2018-02-12",
        "reactivation_date": "2018-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "RI",
            "license": "MD16966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.