Roostam M Kholmatov, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20073 Issued in NV

Practice address

5150 Mae Anne Ave Ste 405-1082
Reno, NV 89523-1858

Phone

(775) 256-9494

NPI assigned

Jul 14, 2017

Last updated

Jun 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 15

Addresses

Other names 1

• Rustam Musurmankulovich Holmatov Former name

Medicare fee-for-service enrollment

Enrolled in VA, NY, SC3 enrollments

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 3

Merit-based Incentive Payment System (MIPS)

Final score

86.15 of 100Reported as group

Quality

78.17

Promoting interoperability

100

Improvement activities

40

Cost

75.68

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Glutality Provider Group, P.a.

  • Internal Medicine Physician
  • Boca Raton, FL
  • NPI 1083256168

  SC, VA

  Medicare reassignment
• Azova Care Group (FL), PLLC

  • Family Medicine Physician
  • Alpine, UT
  • NPI 1285357921
  NPD (past)
• Glutality Provider Group of New Jersey, PA.

  • Internal Medicine Physician
  • Neptune, NJ
  • NPI 1396335675
  NPD (past)

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1497277123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 MAE ANNE AVE STE 405-1082",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895231858",
            "telephone_number": "775-256-9494",
            "fax_number": "775-243-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 MAE ANNE AVE STE 405-1082",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895231858",
            "telephone_number": "775-256-9494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOLMATOV",
        "first_name": "ROOSTAM",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-14",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "92309",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101282111",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "223343",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD485581",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD19899",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "330091",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD220014",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "1020093",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD-24410",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME168657",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2024-0481",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-18151",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2024024345",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "20073",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NV",
            "license": "20073",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUSTAM",
            "last_name": "HOLMATOV",
            "middle_name": "MUSURMANKULOVICH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arshad Mohammad Khanani, M.D.
• Violeta Kharrl
• Esther Khashram
• Mike Khieu, M.D.
• Htet Khine, MD
• Sanchai Khongkhatitham, PT, DPT
• Amr Khorshed, DDS
• Hamid Khorshidi
• Aria Khoshjabinzadeh, DO
• Robert Khoury

• Internal Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.