Individual provider Active NPI

Bilal Ahmad Khan, MD

  • Family Medicine Physician
  • Atlanta, GA
National Provider Identifier
1235494063
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
79314 Issued in GA
Practice address
5665 Peachtree Dunwoody Rd
Atlanta, GA 30342-1764
Phone
(404) 783-7588
NPI assigned
Jul 9, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 79314 GA Primary

Addresses

Primary practice location

5665 Peachtree Dunwoody Rd
Atlanta, GA 30342-1764

Mailing address

2701 N Decatur Rd Ste G-05
Decatur, GA 30033-5918
Phone (404) 365-0966

Other identifiers 1

IdentifierTypeStateIssuer
197110MedicaidAL

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150929001944 AL Practitioner - Family Practice 0941444293 Reassigns benefits to 2 organizations
I20181106000833 GA Practitioner - Hospitalist 0941444293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

20 Glenlake Pkwy
Atlanta, GA 30328-3473
Phone (770) 677-6043

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
79314GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Family Medicine CurrentSince Aug 13, 2018 Accepting new patients
Shoals Primary Care, LLC Family Medicine CurrentSince Aug 20, 2015 Accepting new patients
Ecm Health Group LLC CurrentSince Apr 1, 2017 Accepting new patients

Locations

541 W College St
Ste 3200
Florence, AL 35630
Phone (256) 760-0098

541 W College St
Ste 3300
Florence, AL 35630
Phone (256) 766-6026

426 E Dr Hicks Blvd
Florence, AL 35630
Phone (256) 764-7721

342 Cox Blvd
Sheffield, AL 35660
Phone (256) 383-4473

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

2701 N Decatur Rd
Ste G5
Decatur, GA 30033

5665 Ptree Dunwoody Rd NE
Sandy Springs, GA 30342
Phone (678) 843-7001

20 Glenlake Pkwy
Sandy Springs, GA 30328
Phone (770) 677-6247

Interoperability endpoints

  • Direct secure messaging: bilal.khan.1@19580.direct.athenahealth.com

Organizations & group practices 3

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": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1235494063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 N DECATUR RD STE G-05",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335918",
            "telephone_number": "404-365-0966",
            "fax_number": "256-768-9715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 PEACHTREE DUNWOODY RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421764",
            "telephone_number": "404-783-7588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "BILAL",
        "middle_name": "AHMAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "79314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197110",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5665 Peachtree Dunwoody Rd",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303421764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.