Individual provider Active NPI

Shyam L Khanwani, MD

  • Hematology & Oncology Physician
  • Fayetteville, GA
National Provider Identifier
1184602856
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
051672 Issued in GA
Practice address
132 Old Norton Rd Ste 200
Fayetteville, GA 30215-4873
Phone
(678) 817-1117
Fax
(678) 817-0823
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 051672 GA Primary

Addresses

Primary practice location

132 Old Norton Rd Ste 200
Fayetteville, GA 30215-4873

Mailing address

1835 Savoy Dr
Suite 300
Atlanta, GA 30341-1072
Phone (678) 817-1117

Other identifiers 1

IdentifierTypeStateIssuer
000961925BMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shyam.khanwanimd.p1@direct.gacancer.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080226000492 GA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3678586401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

132 Old Norton Rd
Suite 200
Fayetteville, GA 30215-4873
Phone (678) 817-1117

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
71.19 of 100Reported as group
Quality
69.24
Improvement activities
40
Cost
51.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
051672GAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology Current Accepting new patients
NSH Cancer Institute Professional Services G LLC CurrentSince Jan 1, 2013 Accepting new patients
NSH Cancer Institute Professional Services G, LLC Hematology & Oncology CurrentSince Jan 1, 2013 Accepting new patients
Northside Imaging LLC Past Accepting new patients

Locations

1835 Savoy Dr
Ste 300
Atlanta, GA 30341
Phone (678) 288-9555

132 Old Norton Rd
Ste 200
Fayetteville, GA 30215
Phone (678) 817-1117

620 J L White Dr
Ste 140
Jasper, GA 30143
Phone (706) 253-3500

6300 Hospital Pkwy
Ste 300
Johns Creek, GA 30097
Phone (770) 623-8965

1045 Southcrest Dr
Ste 200
Stockbridge, GA 30281
Phone (678) 289-0549

Interoperability endpoints

  • Direct secure messaging: shyam.khanwanimd.p1@direct.gacancer.nextgenshare.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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1184602856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411072",
            "telephone_number": "678-817-1117",
            "fax_number": "678-817-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 OLD NORTON RD STE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302154873",
            "telephone_number": "678-817-1117",
            "fax_number": "678-817-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANWANI",
        "first_name": "SHYAM",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "051672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000961925B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shyam.khanwanimd.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "132 Old Norton Rd Ste 200",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302154873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.