Khaula Khatlani, M.D.

Primary specialty

Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X

License

66471 Issued in CT

Practice address

975 Farmington Ave Ste 1
Bristol, CT 06010-3964

Phone

(860) 589-0114

Fax

(860) 589-1936

NPI assigned

Aug 25, 2010

Last updated

Sep 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Bristol Hospital Incorporated

  • General Acute Care Hospital
  • Bristol, CT
  • NPI 1619901642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1184930455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 FARMINGTON AVE STE 1",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103964",
            "telephone_number": "860-589-0114",
            "fax_number": "860-589-1936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 FARMINGTON AVE STE 1",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103964",
            "telephone_number": "860-589-0114",
            "fax_number": "860-589-1936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16001 W 9 Mile Rd",
            "address_2": "Department of Surgery,2nd floor",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754818",
            "country_code": "US",
            "telephone_number": "248-849-3073",
            "fax_number": "248-849-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 York Street",
            "address_2": "YNHH Preventive Medicine",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "06510",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHATLANI",
        "first_name": "KHAULA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-25",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": "57453",
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "CT",
            "license": "66471",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301096855",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "66471",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kkhatlan@bristolhopsital.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "975 Farmington Ave Ste 1",
            "city": "Bristol",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060103964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Kelly
• Shane Patrick Kelly, PHARM.D.
• Kayla Nicole Kennedy, PA-C
• Kenneth K. Rhee, MD,PC
• Mia Kercado, LDO
• Ponita Khouy, RD
• Sapna Khubchandani, M.D.
• Kids Dental Care Anesthesia, LLC
• Kids Dental Care, LLC
• Kim Ann Kim, MSN, APRN, PMHNP-BC

• Preventive Medicine/Occupational Environmental Medicine Physician in Bristol, CT
• Providers in Bristol, CT by specialty
• Preventive Medicine/Occupational Environmental Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.