Active NPI
Khashayar Farzam, DO
- Family Medicine Physician
- Iowa City, IA
National Provider Identifier
1255893483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R-11496
- Practice address
- 200 Hawkins Dr
Department of Family Medicine
Iowa City, IA 52242 - Phone
- (319) 384-7222
- NPI assigned
- Apr 5, 2019
- Reactivated
- Nov 26, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | R-11496 | IA | Primary |
Addresses
Primary practice location
200 Hawkins Dr
Department of Family Medicine
Iowa City, IA 52242
Mailing address
200 Hawkins Dr
Department of Family Medicine
Iowa City, IA 52242
Phone (319) 384-7222
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0123917 | Medicaid | IA | |
| R-11496 | Other | IA | BOARD OF MEDICINE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583712000000",
"number": "1255893483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"address_2": "DEPARTMENT OF FAMILY MEDICINE",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "52242",
"telephone_number": "319-384-7222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"address_2": "DEPARTMENT OF FAMILY MEDICINE",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "52242",
"telephone_number": "319-384-7222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARZAM",
"first_name": "KHASHAYAR",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-05",
"last_updated": "2020-03-09",
"certification_date": "2020-03-09",
"deactivation_date": "2019-11-07",
"reactivation_date": "2019-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IA",
"license": "R-11496",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0123917",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF MEDICINE",
"identifier": "R-11496",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.