Individual provider Active NPI

Mafaza Khan, MD

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1275161796
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2023010200 Issued in MO
Practice address
615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone
(314) 251-6339
NPI assigned
Mar 30, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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 2023010200 MO Primary

Addresses

Primary practice location

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Mailing address

621 S New Ballas Rd Ste 112a
Saint Louis, MO 63141-8252
Phone (314) 251-6339

Other practice location 1

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1328

Other practice location 2

901 E 5th St
Washington, MO 63090-3127
Phone (636) 239-8231

Other practice location 3

1400 US Highway 61
Festus, MO 63028-4100
Phone (636) 933-5337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20231010001650 MO Practitioner - Internal Medicine 9931523321 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Adult Hospitalists - St. Louis, LLCGroup PAC ID 6002809944, 139 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6339

Hospital & facility affiliations

  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023010200MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospitals East Communities CurrentSince Sep 1, 2023 Accepting new patients
Mercy Hospitals East Communities CurrentSince Sep 1, 2023 Accepting new patients
St Anthonys Physician Organization Hospitalist Services, L.C. CurrentSince Sep 1, 2023 Accepting new patients
Mercy Clinic Adult Hospitalists - St. Louis, LLC Internal Medicine CurrentSince Sep 1, 2023 Accepting new patients
Mercy Clinic Adult Hospitalists- Jefferson, LLC Internal Medicine CurrentSince Sep 1, 2023 Accepting new patients
Mercy Clinic Adult Hospitalists - Washington, LLC CurrentSince Sep 1, 2023 Accepting new patients
Mercy Hospitals East Communities Internal Medicine Past Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
#H
Saint Louis, MO 63141
Phone (314) 251-6075

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

621 S New Ballas Rd
Ste 112A
Saint Louis, MO 63141
Phone (314) 251-6339

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

Organizations & group practices 7

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 2

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": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1275161796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 112A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418252",
            "telephone_number": "314-251-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10010 Kennerly Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631282106",
            "country_code": "US",
            "telephone_number": "314-525-1328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630903127",
            "country_code": "US",
            "telephone_number": "636-239-8231",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 US Highway 61",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630284100",
            "country_code": "US",
            "telephone_number": "636-933-5337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MAFAZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2023010200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.