NPIMap

Individual provider Active NPI

Ateeque R. Khan, M.D.

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1487689808
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME97554 Issued in FL
Practice address
4466 Swilcan Bridge LN N
Jacksonville, FL 32224-5617
Phone
(904) 599-3225
Fax
(904) 821-8050
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 222724 NY
Internal Medicine Physician 207R00000X ME97554 FL Primary

Addresses

Primary practice location

4466 Swilcan Bridge LN N
Jacksonville, FL 32224-5617

Mailing address

PO Box 552318
Tampa, FL 33655-0001
Phone (904) 599-3225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20080905000277 FL Practitioner - Internal Medicine 3274563705 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Shircliff Way
Jacksonville, FL 32204-4748
Phone (904) 599-3225

Hospital & facility affiliations

  • Ascension St Vincent'S Riverside Hospital, Jacksonville, FL, CCN 100040
  • Ed Fraser Memorial Hospital Hospital, Macclenny, FL, CCN 100134
  • Southeast Georgia Health System- Brunswick Campus Hospital, Brunswick, GA, CCN 110025
  • Southeast Georgia Health System -- Camden Campus Hospital, Saint Marys, GA, CCN 110146
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ateeque Khan, MD P.a. Internal Medicine CurrentSince Mar 9, 2020 Accepting new patients
Hospital Specialists Inc Internal Medicine CurrentSince Apr 1, 2007 Accepting new patients
Horizon Medical Group, P.C. Past Accepting new patients
Monroe Area Medical Associates, PC Past Accepting new patients

Locations

1 Shircliff Way
Jacksonville, FL 32204
Phone (904) 332-0414

9838 Old Baymeadows Rd
Jacksonville, FL 32256
Phone (904) 472-0537

Organizations & group practices 4

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 7

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1487689808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 552318",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336550001",
            "telephone_number": "904-599-3225",
            "fax_number": "904-281-9806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4466 SWILCAN BRIDGE LN N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322245617",
            "telephone_number": "904-599-3225",
            "fax_number": "904-821-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ATEEQUE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "222724",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME97554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.