Active NPI
Maria Cristina Khan, M.D.
- Pediatrics Physician
- Davenport, FL
National Provider Identifier
1467474825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME0076328
- Practice address
- 103 Park Place Blvd
Davenport, FL 33837-6858 - Phone
- (863) 421-1855
- Fax
- (863) 421-2624
- NPI assigned
- Jul 24, 2006
- Last updated
- Feb 24, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME0076328 | FL | Primary |
Addresses
Primary practice location
103 Park Place Blvd
Davenport, FL 33837-6858
Mailing address
103 Park Place Blvd
Davenport, FL 33837-6858
Phone (863) 421-1855
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 265775000 | Medicaid | FL | |
| 44550 | Other | FL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0076328 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Davenport Pediatrics | Single Specialty | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FGDHBA
- maria.khan@davpeds.eclinicaldirectplus.com
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487894400000",
"number": "1467474825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 PARK PLACE BLVD",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338376858",
"telephone_number": "863-421-1855",
"fax_number": "863-421-2624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 PARK PLACE BLVD",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338376858",
"telephone_number": "863-421-1855",
"fax_number": "863-421-2624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "MARIA CRISTINA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2017-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME0076328",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "265775000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "44550",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.