Individual provider Active NPI

Shaheed Khan, MD

  • Internal Medicine Physician
  • Springfield Gardens, NY
National Provider Identifier
1427066414
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
170541 Issued in NY
Practice address
134-21 Springfield Blvd
Springfield Gardens, NY 11413
Phone
(718) 528-6377
Fax
(718) 949-4580
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 170541 NY Primary

Addresses

Primary practice location

134-21 Springfield Blvd
Springfield Gardens, NY 11413

Mailing address

134-21 Springfield Blvd
Springfield Gardens, NY 11413
Phone (718) 528-6377

Other identifiers 1

IdentifierTypeStateIssuer
01022095MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090921000128 NY Practitioner - Internal Medicine 6204982002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
170154NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Shaheed Khan M.D.,P.C. Internal Medicine CurrentSince Aug 1, 2009 Accepting new patients

Locations

13421 Springfield Blvd
Sprngfld Gdns, NY 11413
Phone (718) 528-6377

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1427066414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134-21 SPRINGFIELD BLVD",
            "city": "SPRINGFIELD GARDENS",
            "state": "NY",
            "postal_code": "11413",
            "telephone_number": "718-528-6377",
            "fax_number": "718-949-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134-21 SPRINGFIELD BLVD",
            "city": "SPRINGFIELD GARDENS",
            "state": "NY",
            "postal_code": "11413",
            "telephone_number": "718-528-6377",
            "fax_number": "718-949-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SHAHEED",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "170541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01022095",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield Gardens, NY

Sources for this page

Verify at the official NPI Registry.