Individual provider Active NPI

Hamzah Mohsin Khan

  • Internal Medicine Physician
  • Jacksonville, NC
National Provider Identifier
1396410775
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2024-02555 Issued in NC
Practice address
317 Western Blvd
Jacksonville, NC 28546-6338
Phone
(910) 577-2345
NPI assigned
Aug 9, 2021
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 2024-02555 NC Primary

Addresses

Primary practice location

317 Western Blvd
Jacksonville, NC 28546-6338

Mailing address

111 E 210TH St
Bronx, NY 10467-2401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241008000328 NC Practitioner - Internal Medicine 9638600240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group North CarolinaGroup PAC ID 7719162254, 78 clinicians

Practice addresses (Care Compare)

317 Western Blvd
Jacksonville, NC 28546-6338
Phone (910) 577-2345

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024-02555NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group North Carolina CurrentSince Sep 5, 2024 Accepting new patients

Locations

317 Western Blvd
Jacksonville, NC 28546
Phone (910) 577-2240

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

Organizations & group practices 1

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 1

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": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1396410775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466338",
            "telephone_number": "910-577-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "HAMZAH",
        "middle_name": "MOHSIN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-09",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2024-02555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.