NPIMap

Individual provider Active NPI

Mohammad Asim Khan, M.D.

  • Internal Medicine Physician
  • Kissimmee, FL
National Provider Identifier
1265478226
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME76641 Issued in FL
Practice address
3020 Park Pond Way
Kissimmee, FL 34741-7662
Phone
(407) 978-6021
Fax
(407) 978-6386
NPI assigned
Jun 20, 2006
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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 ME76641 FL Primary

Addresses

Primary practice location

3020 Park Pond Way
Kissimmee, FL 34741-7662

Mailing address

3020 Park Pond Way
Kissimmee, FL 34741-7662
Phone (407) 978-6021

Other identifiers 1

IdentifierTypeStateIssuer
257403900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20060728000258 FL Practitioner - Internal Medicine 8921011479 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Astha HealthGroup PAC ID 9931589892, 30 clinicians

Practice addresses (Care Compare)

3020 Park Pond Way
Kissimmee, FL 34741-7662
Phone (407) 978-6021

804 Emmett St
Kissimmee, FL 34741-5434
Phone (407) 785-1111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME76641FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Astha Health CurrentSince Oct 23, 2023 Accepting new patients
Yusra Medical Associates P.a. CurrentSince Jan 6, 2013 Accepting new patients
Halifax Healthcare Systems Inc Past Accepting new patients
Volusia Hospitalists PLC Internal Medicine PastSince Aug 27, 2023 Accepting new patients

Locations

3020 Park Pond Way
Kissimmee, FL 34741
Phone (407) 978-6021

804 Emmett St
Kissimmee, FL 34741
Phone (407) 449-4559

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGEDAD/Endpoint/DGEDAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/DGEDAD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1265478226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 PARK POND WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417662",
            "telephone_number": "407-978-6021",
            "fax_number": "407-978-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 PARK POND WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417662",
            "telephone_number": "407-978-6021",
            "fax_number": "407-978-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMAD",
        "middle_name": "ASIM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME76641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257403900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.