Individual provider Active NPI

Stephanie M Khan

  • Primary Care Nurse Practitioner
  • Forest Hills, NY
National Provider Identifier
1366961526
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
341863 Issued in NY
Practice address
11078 Queens Blvd
Forest Hills, NY 11375-6345
Phone
(718) 309-2827
NPI assigned
Sep 19, 2017
Last updated
Jan 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F341863 NY
Primary Care Nurse Practitioner 363LP2300X 341863 NY Primary
Inpatient Obstetric Registered Nurse 163WX0003X 660206 NY
Family Medicine Physician 207Q00000X 341863 NY

Addresses

Primary practice location

11078 Queens Blvd
Forest Hills, NY 11375-6345

Mailing address

9532 75TH St
Ozone Park, NY 11416-1006

Other practice location 1

560 1st Ave
New York, NY 10016-6402
Phone (212) 263-7000

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address skhan41268@nyumc.direct-ci.com
CONNECT URL https://www.tebra.com/care/provider/stephanie-khan-1366961526

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200803000385 NY Practitioner - Nurse Practitioner 8921423336 Reassigns benefits to 1 organization
Practice locations: Forest Hills, NY

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

11078 Queens Blvd
Forest Hills, NY 11375-6345
Phone (718) 309-2827

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

145 E 32 St
New York, NY 10016-6055
Phone (212) 263-3210

145 E 32ND St
FL 2
New York, NY 10016-6055
Phone (212) 263-3210

333 E 38TH St
New York, NY 10016-2772
Phone (646) 356-9400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
660206NYMDInpatient Obstetric Registered Nurse
341863NYMDFamily Medicine Physician
F341863NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Jun 1, 2020 Accepting new patients
New York University CurrentSince Jun 1, 2020 Accepting new patients

Locations

560 1st Ave
New York, NY 10016
Phone (212) 263-5362

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

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 7

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": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1366961526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9532 75TH ST",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114161006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11078 QUEENS BLVD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756345",
            "telephone_number": "718-309-2827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "560 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100166402",
            "country_code": "US",
            "telephone_number": "212-263-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "STEPHANIE",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-19",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F341863",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NY",
            "license": "341863",
            "primary": true
        },
        {
            "code": "163WX0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, Inpatient",
            "state": "NY",
            "license": "660206",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "341863",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "skhan41268@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "560 1st Ave",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100166402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.tebra.com/care/provider/stephanie-khan-1366961526",
            "affiliation": "N",
            "address_1": "11078 Queens Blvd",
            "city": "Forest Hills",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113756345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.