NPIMap

Individual provider Active NPI

Baber Nazir Khatib, MD, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Portland, OR
National Provider Identifier
1356662845
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
MD196775 Issued in OR
Practice address
1849 NW Kearney St Ste 300
Portland, OR 97209-1453
Phone
(503) 224-1371
Fax
(503) 224-0722
NPI assigned
Jun 18, 2010
Last updated
Jan 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X MD196775 OR Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D11193 OR

Addresses

Primary practice location

1849 NW Kearney St Ste 300
Portland, OR 97209-1453

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.head-neck.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20200217000750 OR Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 0143595306 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
University of California, Davis School of Medicine, 2014
Medicare assignment
May accept Medicare assignment
Group practices
Head and Neck Surgical Associates, PCGroup PAC ID 4486544418, 5 clinicians
TS Billings LLCGroup PAC ID 0143201954, 5 clinicians

Practice addresses (Care Compare)

1849 NW Kearney St
Suite 300
Portland, OR 97209-1453
Phone (503) 224-1371

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 528-0704

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35SCMDPeriodontist
D11193ORMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
TS Billings, LLC CurrentSince Jun 27, 2020 Accepting new patients
Head & Neck Surgical Associates, PC Oral & Maxillofacial Surgery CurrentSince Dec 15, 2019 Accepting new patients
Oag Trauma Services LLC Past Accepting new patients

Locations

1849 NW Kearney St
Ste 300
Portland, OR 97209
Phone (503) 224-1371

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

501 N Graham St
Ste 275
Portland, OR 97227
Phone (503) 915-6030

Interoperability endpoints

  • Direct secure messaging: bkhatib619221@oc.providencedirect.org

Organizations & group practices 3

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": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1356662845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1849 NW KEARNEY ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972091453",
            "telephone_number": "503-224-1371",
            "fax_number": "503-224-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHATIB",
        "first_name": "BABER",
        "middle_name": "NAZIR",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-18",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OR",
            "license": "MD196775",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D11193",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.head-neck.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "address_1": "1849 NW Kearney St Ste 300",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972091453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.