NPIMap

Individual provider Active NPI

Adeel Khan, M.D.

  • Nephrology Physician
  • Midland, MI
National Provider Identifier
1467481465
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301062170 Issued in MI
Practice address
415 W Wackerly St
Midland, MI 48640-2761
Phone
(989) 837-6505
Fax
(989) 835-8428
NPI assigned
Jul 2, 2006
Last updated
Jan 22, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301062170 MI Primary

Addresses

Primary practice location

415 W Wackerly St
Midland, MI 48640-2761

Mailing address

415 W Wackerly St
Midland, MI 48640-2761
Phone (989) 837-6505

Other identifiers 8

IdentifierTypeStateIssuer
1006835OtherMIMCLAREN HEALTH PLAN
1011192OtherMIMCLAREN HEALTH PLAN
1032653OtherMIMCLAREN
200000014300OtherMIPHP COML.
4584928MedicaidMI
1105610461OtherMIBCBSM
0989454OtherMIHEALTHPLUS COMMERCIAL
200000005783OtherMIPHP COMMERCIAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040217000564 MI Practitioner - Nephrology 7012802283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Renal Associates of Mid-Michigan PCGroup PAC ID 3072684638, 3 clinicians

Practice addresses (Care Compare)

1200 E N Down River Rd
Grayling, MI 49738-7131
Phone (989) 837-6505

1989 Walden Dr
Gaylord, MI 49735-8241
Phone (989) 731-6418

415 W Wackerly St
Midland, MI 48640-2739
Phone (989) 837-6505

415 W Wackerly St
Midland, MI 48640-2761

609 Quarter St
Gladwin, MI 48624-1941
Phone (989) 837-6505

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Renal Associates of Mid-Michigan PC Nephrology CurrentSince Jun 25, 2008 Accepting new patients
Mymichigan Medical Center Alma Nephrology Past Accepting new patients
Mymichigan Medical Center Alma Past Accepting new patients

Locations

300 E Warwick Dr
Alma, MI 48801
Phone (989) 463-0104

330 E Warwick Dr
Alma, MI 48801
Phone (989) 466-3330

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

415 W Wackerly St
Midland, MI 48640
Phone (989) 837-6505

Interoperability endpoints

  • Direct secure messaging: adeel.khan@direct.davitaphysiciansolutions.com

Organizations & group practices 3

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 12

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": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1467481465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402761",
            "telephone_number": "989-837-6505",
            "fax_number": "989-835-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W WACKERLY ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486402761",
            "telephone_number": "989-837-6505",
            "fax_number": "989-835-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ADEEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301062170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1006835",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1011192",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN",
            "identifier": "1032653",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP COML.",
            "identifier": "200000014300",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4584928",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1105610461",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS COMMERCIAL",
            "identifier": "0989454",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP COMMERCIAL",
            "identifier": "200000005783",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.