Individual provider Active NPI

Khampha Thephavong, D.O

  • Internal Medicine Physician
  • Fresno, CA
National Provider Identifier
1194901173
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A9790 Issued in CA
Practice address
2823 Fresno St
Fresno, CA 93721-1324
Phone
(559) 459-6000
NPI assigned
Jan 21, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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 20A9790 CA Primary

Addresses

Primary practice location

2823 Fresno St
Fresno, CA 93721-1324

Mailing address

5068 E Home Ave
Fresno, CA 93727-1948
Phone (805) 234-0871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100507000304 CA Practitioner - Internal MedicinePractitioner - Osteopathic Manipulative Medicine 7416085766 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio State University College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Health PartnersGroup PAC ID 6608280268, 497 clinicians

Practice addresses (Care Compare)

245 W Herndon Ave
Clovis, CA 93612-0204
Phone (559) 299-1178

45 E River Park PL W
Fresno, CA 93720-1565
Phone (559) 320-0530

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.04 of 100Reported as group
Quality
78.62
Promoting interoperability
100
Improvement activities
40
Cost
75.31

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Smartcare Medical Group, Inc. CurrentSince May 1, 2023 Accepting new patients
Reedley Community Hospital CurrentSince Jul 1, 2021 Accepting new patients
Reedley Community Hospital CurrentSince Jul 1, 2021 Accepting new patients
Community Health Partners CurrentSince Mar 24, 2023 Accepting new patients
Hanford Community Hospital Past Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients

Locations

255 W Herndon Ave
Ste 103
Clovis, CA 93612
Phone (559) 326-2999

245 W Herndon Ave
Clovis, CA 93612
Phone (559) 299-1178

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

45 E River Park Pl W
Ste 104
Fresno, CA 93720
Phone (559) 320-0550

7035 N Maple Ave
Ste 102B
Fresno, CA 93720
Phone (559) 299-2997

372 W Cypress Ave
Reedley, CA 93654
Phone (559) 391-3110

805 W Acequia Ave
Ste 2D
Visalia, CA 93291
Phone (559) 622-8687

Organizations & group practices 6

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 1

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": "1200873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1194901173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5068 E HOME AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937271948",
            "telephone_number": "805-234-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211324",
            "telephone_number": "559-459-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEPHAVONG",
        "first_name": "KHAMPHA",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-21",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A9790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.