NPIMap

Individual provider Active NPI

Imtiaz R Khan

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Baton Rouge, LA
National Provider Identifier
1306137666
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
313117 Issued in LA
Practice address
2223 Quail Run Ste E
Baton Rouge, LA 70808-9063
Phone
(225) 877-2872
NPI assigned
Apr 21, 2011
Last updated
Nov 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301505573 MI
Surgery Physician 208600000X 313117 LA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 4301505573 MI
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 313117 LA Primary

Addresses

Primary practice location

2223 Quail Run Ste E
Baton Rouge, LA 70808-9063

Mailing address

2223 Quail Run Ste E
Baton Rouge, LA 70808-9063
Phone (225) 877-2872

Other practice location 1

1100 E Michigan Ave Ste 201
Jackson, MI 49201-1849
Phone (517) 205-1430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MI, PA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190730003530 LA Practitioner - Thoracic Surgery 3072849942 Reassigns benefits to 2 organizations
I20210917001455 MI Practitioner - Thoracic SurgeryPractitioner - General SurgeryPractitioner - Cardiovascular Disease (Cardiology) 3072849942 Reassigns benefits to 1 organization
I20240607002900 PA Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 3072849942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: Cardiovascular Disease (Cardiology), General Surgery
Education
Louisiana State University School of Medicine in Shreveport, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians

Practice addresses (Care Compare)

1100 E Michigan Ave
201 Henry Ford Allegiance Outpatient Trauma
Jackson, MI 49201-1849
Phone (517) 205-7069

145 Hospital Ave
Suite 300
Du Bois, PA 15801-1465
Phone (814) 375-2040

2223 Quail Run
Suite E
Baton Rouge, LA 70808-9063
Phone (225) 877-2872

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
313117LAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsuhn Billing LLC CurrentSince Jan 1, 2020 Accepting new patients
Dubois Regional Medical Center CurrentSince May 4, 2024 Accepting new patients
Baton Rouge General Physicians, Inc. CurrentSince Sep 1, 2022 Accepting new patients
W.a. Foote Memorial Hospital CurrentSince Sep 1, 2021 Accepting new patients
Baton Rouge General Physicians, Inc. Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Sep 1, 2022 Accepting new patients
W. a. Foote Memorial Hospital Current Accepting new patients
W.a. Foote Memorial Hospital Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince Sep 1, 2021 Accepting new patients
Dubois Regional Medical Center Thoracic Surgery (Cardiothoracic Vascular Surgery) CurrentSince May 4, 2024 Accepting new patients
Lsuhn Billing LLC CurrentSince Jan 1, 2020 Accepting new patients
CVT Vascular Lab, Inc Past Accepting new patients

Locations

2223 Quail Run
Ste E
Baton Rouge, LA 70808
Phone (225) 769-7560

7777 Hennessy Blvd
Ste 1008
Baton Rouge, LA 70808
Phone (225) 766-0416

8595 Picardy Ave
Ste 110
Baton Rouge, LA 70809
Phone (225) 767-6090

8595 Picardy Ave
Ste 320
Baton Rouge, LA 70809
Phone (225) 237-1880

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-4316

1100 E Michigan Ave
Ste 201
Jackson, MI 49201
Phone (517) 205-7605

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

100 Hospital Ave
Ofc
Dubois, PA 15801

145 Hospital Ave
Ste 300
Dubois, PA 15801
Phone (814) 371-4524

Interoperability endpoints

  • Direct secure messaging: ikhan753125@direct.hfhs.org

Organizations & group practices 10

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1306137666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 QUAIL RUN STE E",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089063",
            "telephone_number": "225-877-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 QUAIL RUN STE E",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089063",
            "telephone_number": "225-877-2872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 E Michigan Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MI",
            "postal_code": "492011849",
            "country_code": "US",
            "telephone_number": "517-205-1430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "IMTIAZ",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-21",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301505573",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "313117",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "4301505573",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "LA",
            "license": "313117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.