NPIMap

Individual provider Active NPI

Nusrat Ali Khan, M.D.

  • Internal Medicine Physician
  • Willow Park, TX
National Provider Identifier
1316053408
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M5284 Issued in TX
Practice address
5077 E Interstate 20 Service Rd N
Willow Park, TX 76087-3219
Phone
(817) 374-4949
NPI assigned
Aug 22, 2006
Last updated
Jan 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M5284 TX Primary
Pediatrics Physician 208000000X M5284 TX

Addresses

Primary practice location

5077 E Interstate 20 Service Rd N
Willow Park, TX 76087-3219

Mailing address

PO Box 1313
Weatherford, TX 76086-1313
Phone (817) 374-4949

Other identifiers 1

IdentifierTypeStateIssuer
2176497-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20070627000389 TX Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6305872342 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Brody School of Medicine at East Carolina University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

5077 E Interstate 20 Service Rd N
Khan Medical Clinic
Willow Park, TX 76087-3219
Phone (682) 229-6040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
16.81 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
56.04

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medpeds Medical Clinic, PA Internal Medicine Current Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Riverside Health System Past Accepting new patients

Locations

2111 Fort Worth Hwy
Weatherford, TX 76086
Phone (817) 596-3700

Interoperability endpoints

  • Direct secure messaging: nusrat.khan@khanmedical.eclinicaldirectplus.com

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 9

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1316053408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1313",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760861313",
            "telephone_number": "817-374-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5077 E INTERSTATE 20 SERVICE RD N",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760873219",
            "telephone_number": "817-374-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NUSRAT",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M5284",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M5284",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2176497-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Park, TX

Sources for this page

Verify at the official NPI Registry.