NPIMap

Individual provider Active NPI

Mohammad Siddique Khan

  • Hematology & Oncology Physician
  • Newburgh, IN
National Provider Identifier
1376070540
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
01093403A Issued in IN
Practice address
4055 Gateway Blvd
Newburgh, IN 47630-7451
Phone
(812) 858-0723
NPI assigned
May 17, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 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 58008291 OH
Hematology & Oncology Physician 207RH0003X 01093403A IN Primary

Addresses

Primary practice location

4055 Gateway Blvd
Newburgh, IN 47630-7451

Mailing address

4055 Gateway Blvd
Newburgh, IN 47630-7451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, IN2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20200929000655 CA Practitioner - Hospitalist 0648548453 Reassigns benefits to 3 organizations
I20240703000727 IN Practitioner - Hematology/Oncology 0648548453 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4099 Gateway Blvd
Newburgh, IN 47630-8947
Phone (812) 858-3051

520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 885-3280

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.62 of 100Reported as group
Quality
72.6
Promoting interoperability
100
Improvement activities
40
Cost
69.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58008291OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Physician Services, Inc Internal Medicine CurrentSince Jul 31, 2025 Accepting new patients
Deaconess Specialty Physicians Inc CurrentSince Jun 1, 2024 Accepting new patients
University of California San Francisco CurrentSince Jul 30, 2020 Accepting new patients
UCSF Medical Group Business Services Internal Medicine CurrentSince Jul 30, 2020 Accepting new patients
Deaconess Specialty Physicians, Inc Current Accepting new patients
University of California San Francisco Internal Medicine CurrentSince Jul 30, 2020 Accepting new patients
UCSF Medical Group Business Services CurrentSince Jul 30, 2020 Accepting new patients
Good Samaritan Hospital CurrentSince Jul 31, 2025 Accepting new patients
Deaconess Specialty Physicians Inc Hematology & Oncology CurrentSince Jun 1, 2024 Accepting new patients
Regents of the University of California Internal Medicine CurrentSince Jul 30, 2020 Accepting new patients
University of California San Francisco Current Accepting new patients
Good Samaritan Hospital Physician Services Inc. Past Accepting new patients

Locations

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

600 Mary St
Evansville, IN 47710
Phone (812) 450-2239

4099 Gateway Blvd
Newburgh, IN 47630
Phone (812) 842-2720

4055 Gateway Blvd
Newburgh, IN 47630
Phone (812) 842-2210

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

Interoperability endpoints

  • Direct secure messaging: mkhan409493@direct.deaconess.com

Organizations & group practices 12

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.

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": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1376070540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476307451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476307451",
            "telephone_number": "812-858-0723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMAD",
        "middle_name": "SIDDIQUE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-17",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "58008291",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IN",
            "license": "01093403A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.