NPIMap

Individual provider Active NPI

Yassin Khattab, M.D.

  • Family Medicine Physician
  • Paintsville, KY
National Provider Identifier
1376650317
Registry record updated Mar 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31556 Issued in KY
Practice address
822 S Mayo TRL
Paintsville, KY 41240-1384
Phone
(606) 789-5541
Fax
(606) 789-9445
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31556 KY Primary

Addresses

Primary practice location

822 S Mayo TRL
Paintsville, KY 41240-1384

Mailing address

822 S Mayo TRL
Paintsville, KY 41240-1384
Phone (606) 789-5541

Other identifiers 4

IdentifierTypeStateIssuer
000000203757OtherKYBLUE CROSS/BLUE SHIELD
31001019MedicaidKY
64315567MedicaidKY
65935025MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20050818000884 KY Practitioner - Pediatric MedicinePractitioner - Family Practice 6901836964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SN Kentuckiana Rehab, LLCGroup PAC ID 1254671464, shared by 19 NPIs, 339 clinicians

Practice addresses (Care Compare)

1005 N Dupont SQ
Suite B
Louisville, KY 40207-4666
Phone (606) 789-5541

12613 Taylorsville Rd
Suite 118
Louisville, KY 40299-5496
Phone (502) 267-1480

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sunshine Pediatrics of Louisville LLC Family Medicine CurrentSince Jan 15, 2018 Accepting new patients
Norton Hospitals, Inc Past Accepting new patients

Locations

1005 N DuPont Sq
Ste B
Louisville, KY 40207
Phone (502) 896-2131

1005 N DuPont Sq
Louisville, KY 40207
Phone (502) 893-5677

822 S Mayo Trl
Paintsville, KY 41240
Phone (606) 789-5541

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IDJCBD/Endpoint/IDJCBD

Organizations & group practices 2

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364169600000",
    "number": "1376650317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 S MAYO TRL",
            "city": "PAINTSVILLE",
            "state": "KY",
            "postal_code": "412401384",
            "telephone_number": "606-789-5541",
            "fax_number": "606-789-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 S MAYO TRL",
            "city": "PAINTSVILLE",
            "state": "KY",
            "postal_code": "412401384",
            "telephone_number": "606-789-5541",
            "fax_number": "606-789-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHATTAB",
        "first_name": "YASSIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2013-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "31556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "000000203757",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31001019",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64315567",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65935025",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paintsville, KY

Sources for this page

Verify at the official NPI Registry.