Individual provider Active NPI

Robert Khanlian, MD

  • Emergency Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1235352691
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
78-198 Issued in NM
Practice address
275 E 200 S
Salt Lake City, UT 84111-2002
Phone
(505) 379-2623
NPI assigned
Apr 11, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 78-198 NM Primary

Addresses

Primary practice location

275 E 200 S
Salt Lake City, UT 84111-2002

Mailing address

PO Box 1447
Corrales, NM 87048-1447
Phone (505) 379-2623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20080926000442 NM Practitioner - Emergency Medicine 3375631385 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
78-198NMMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Mexico Em-1 Medical Services, P.C. Emergency Medicine Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235352691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1447",
            "city": "CORRALES",
            "state": "NM",
            "postal_code": "870481447",
            "telephone_number": "505-379-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 E 200 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841112002",
            "telephone_number": "505-379-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANLIAN",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "78-198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.