Farhoud Khosravi, D.O.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

206386 Issued in AK

Practice address

2490 S Woodworth Loop Ste 200
Palmer, AK 99645-7410

Phone

(907) 861-6315

NPI assigned

Mar 2, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ, AK, TX3 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 3

Specialty

Gastroenterology

Education

Nova Southeastern College of Osteo Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Arizona Healthcare CorporationGroup PAC ID 3577473362, 391 clinicians

Alaska Gi Associates LLCGroup PAC ID 8426543323, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023
• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: farhoud.khosravi.1@15989.direct.athenahealth.com
• Direct secure messaging: farhoud.khosravi.1@2839.direct.athenahealth.com

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.

• Alaska Gi Associates LLC

  • Gastroenterology Physician
  • Wasilla, AK
  • NPI 1669365698
  Medicare reassignment Care Compare group NPD
• Northern Arizona Healthcare Corporation

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1669914552

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Tanana Chiefs Conference

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1821201278

  TX

  Medicare reassignment NPD
• Arizona Centers for Digestive Health LLC

  • Gastroenterology Physician
  • Gilbert, AZ
  • NPI 1568975316
  Medicare reassignment NPD
• TMC Medical Network

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1750832283
  Medicare reassignment NPD
• Island Dream Devlopment LLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1922767607
  NPD Authorized official
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1821368218
  Medicare reassignment
• Tanana Chiefs Conference

  • Ambulatory Surgical Clinic/Center
  • Fairbanks, AK
  • NPI 1871332387
  NPD
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1316228802
  NPD
• Banner Physician Specialists Arizona LLC

  • Multi-Specialty Clinic/Center
  • Page, AZ
  • NPI 1366799355
  NPD
• Northern Arizona Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1235732702
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation
• Flagstaff Medical Center

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875
  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  Care Compare affiliation

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

{
    "created_epoch": "1235952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1285874362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 S VAL VISTA DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852952152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 S WOODWORTH LOOP STE 200",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457410",
            "telephone_number": "907-861-6315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Thomas Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134255",
            "country_code": "US",
            "telephone_number": "602-406-1510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1601 NW 114th St",
            "address_2": "Suite 342",
            "address_purpose": "LOCATION",
            "city": "Clive",
            "state": "IA",
            "postal_code": "503257007",
            "country_code": "US",
            "telephone_number": "515-222-7600",
            "fax_number": "515-222-7601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOSRAVI",
        "first_name": "FARHOUD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-02",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "DO-04549",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02003720A",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "006861",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AK",
            "license": "206386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "farhoud.khosravi.1@2839.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2490 S Woodworth Loop Ste 200",
            "city": "Palmer",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996457410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Colleen Kersgard, MD
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• Lizzie Killian
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• Gastroenterology Physician in Palmer, AK
• Providers in Palmer, AK by specialty
• Gastroenterology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.