NPIMap

Individual provider Active NPI

Hasan Karim Khondker, M.D.

  • Nephrology Physician
  • Riverhead, NY
National Provider Identifier
1194972729
Registry record updated Nov 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
254607 Issued in NY
Practice address
758 Harrison Ave
Riverhead, NY 11901-2744
Phone
(631) 727-5112
Fax
(631) 727-9061
NPI assigned
Aug 26, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 254607 NY Primary

Addresses

Primary practice location

758 Harrison Ave
Riverhead, NY 11901-2744

Mailing address

758 Harrison Ave
Riverhead, NY 11901-2744
Phone (631) 727-5112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110513000262 NY Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Hospitalist 9436335122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Hospitalist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Suffolk Medical PCGroup PAC ID 0244396349, 204 clinicians

Practice addresses (Care Compare)

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6000

758 Harrison Ave
Riverhead, NY 11901-2744
Phone (631) 727-5112

Hospital & facility affiliations

  • Atlantic DMS - East End Harrison Ave Dialysis facility, Riverhead, NY, CCN 332658
  • Peconic Bay Medical Center Hospital, Riverhead, NY, CCN 330107
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043

Merit-based Incentive Payment System (MIPS)

Final score
22.53 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.1

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Suffolk, P.C CurrentSince Oct 1, 2022 Accepting new patients
Hasan Khondker Medical PC Nephrology CurrentSince Oct 8, 2015 Accepting new patients
St Charles Hospital Corp Past Accepting new patients

Locations

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

758 Harrison Ave
Riverhead, NY 11901
Phone (531) 727-5112

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: hkhondker66908@northwell.direct-ci.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 10

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": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1194972729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 HARRISON AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012744",
            "telephone_number": "631-727-5112",
            "fax_number": "631-727-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 HARRISON AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012744",
            "telephone_number": "631-727-5112",
            "fax_number": "631-727-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHONDKER",
        "first_name": "HASAN",
        "middle_name": "KARIM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "254607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.