NPIMap

Individual provider Active NPI

Nidaa Khamousia, M.D.

  • Internal Medicine Physician
  • Maumee, OH
National Provider Identifier
1184687014
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35087356 Issued in OH
Practice address
6450 Wheatstone CT
Maumee, OH 43537-9402
Phone
(419) 866-6200
Fax
(419) 866-7170
NPI assigned
Apr 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35087356 OH Primary

Addresses

Primary practice location

6450 Wheatstone CT
Maumee, OH 43537-9402

Mailing address

6450 Wheatstone CT
Maumee, OH 43537-9402
Phone (419) 866-6200

Other identifiers 1

IdentifierTypeStateIssuer
2633396MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20060301000002 OH Practitioner - Internal MedicinePractitioner - Preventive Medicine 9537175534 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Preventive Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Toledo Clinic IncorporatedGroup PAC ID 5698673382, 204 clinicians

Practice addresses (Care Compare)

6450 Wheatstone CT
Maumee, OH 43537-9402
Phone (419) 866-6200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35087356OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Toledo Clinic Incorporated CurrentSince Feb 1, 2016 Accepting new patients
Toledo Clinic Incorporated Current Accepting new patients
Toledo Clinic Incorporated Internal Medicine CurrentSince Feb 1, 2016 Accepting new patients
Toledo Clinic Incorporated Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

6450 Wheatstone Ct
Maumee, OH 43537
Phone (419) 861-2333

4235 Secor Rd
Toledo, OH 43623
Phone (419) 214-4214

Interoperability endpoints

  • Direct secure messaging: nidaa.khamousia@toledoclinic.eclinicaldirectplus.com

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.

Hospital & facility affiliations 7

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1184687014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6450 WHEATSTONE CT",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379402",
            "telephone_number": "419-866-6200",
            "fax_number": "419-866-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6450 WHEATSTONE CT",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435379402",
            "telephone_number": "419-866-6200",
            "fax_number": "419-866-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAMOUSIA",
        "first_name": "NIDAA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35087356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2633396",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

Verify at the official NPI Registry.