NPIMap

Individual provider Active NPI

Mutahir Ubaid Khan, M.D.

  • Cardiovascular Disease Physician
  • Modesto, CA
National Provider Identifier
1164734489
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A112898 Issued in CA
Practice address
1401 Spanos CT
Suite 230
Modesto, CA 95355-2810
Phone
(209) 522-9863
NPI assigned
Jul 2, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A112898 CA Primary

Addresses

Primary practice location

1401 Spanos CT
Suite 230
Modesto, CA 95355-2810

Mailing address

1401 Spanos CT
Suite 230
Modesto, CA 95355-2810
Phone (209) 522-9863

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100916001240 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1254456056 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanislaus Cardiology GroupGroup PAC ID 2264468008, 6 clinicians

Practice addresses (Care Compare)

3621 Forest Glenn Dr
Modesto, CA 95355-1339
Phone (209) 521-9661

654 Lyell Dr a
Modesto, CA 95356-8997
Phone (209) 521-9661

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as individual
Quality
82.37
Improvement activities
40
Cost
89.57

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting19
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A112898CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanislaus Cardiology Group CurrentSince Aug 1, 2010 Accepting new patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
San Joaquin Community Hospital Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients
Emanuel Medical Center, Inc. Past Accepting new patients
Summit Surgery Center Modesto, Inc Cardiovascular Disease Past Accepting new patients

Locations

1401 Spanos Ct
Ste 230
Modesto, CA 95355
Phone (209) 521-9661

654 Lyell Dr
Ste A
Modesto, CA 95356
Phone (209) 521-9661

3621 Forest Glenn Dr
Modesto, CA 95355
Phone (209) 521-7411

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: khan@stancard.gwaydirect.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1022
  • Direct secure messaging: mkhan232332@hpmg.direct-ci.net

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278028800000",
    "number": "1164734489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 SPANOS CT",
            "address_2": "SUITE 230",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552810",
            "telephone_number": "209-522-9863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SPANOS CT",
            "address_2": "SUITE 230",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552810",
            "telephone_number": "209-522-9863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MUTAHIR",
        "middle_name": "UBAID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-02",
        "last_updated": "2010-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A112898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.