NPIMap

Individual provider Active NPI

Fazel A Khan, M.D.

  • Orthopaedic Surgery Physician
  • East Setauket, NY
National Provider Identifier
1497732820
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
252511-1 Issued in NY
Practice address
14 Technology Dr
Suite 11
East Setauket, NY 11733-3472
Phone
(631) 444-4233
Fax
(631) 444-3403
NPI assigned
Dec 28, 2005
Last updated
Sep 19, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 252511-1 NY Primary

Addresses

Primary practice location

14 Technology Dr
Suite 11
East Setauket, NY 11733-3472

Mailing address

14 Technology Dr
Suite 11
East Setauket, NY 11733-3472
Phone (631) 444-4233

Other identifiers 1

IdentifierTypeStateIssuer
357146700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110811000298 NY Practitioner - Orthopedic Surgery 8325078744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
State University of New York Downstate Medical Center, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

14 Technology Dr
Suite 11
East Setauket, NY 11733-3464
Phone (631) 444-4233

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement41
Knee replacement68
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
252511-1NYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Orthopaedic Associates, University Faculty Practice Corpor Orthopaedic Surgery CurrentSince Aug 29, 2011 Accepting new patients
University Associates in Obstetrics & Gynecology, University Faculty P Past Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

14 Technology Dr
Ste 11
East Setauket, NY 11733

14 Technology Dr
Setauket, NY 11733
Phone (516) 444-1357

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: fazel.khan@direct.stonybrookmedicine.edu

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 9

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411084800000",
    "number": "1497732820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 TECHNOLOGY DR",
            "address_2": "SUITE 11",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333472",
            "telephone_number": "631-444-4233",
            "fax_number": "631-444-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 TECHNOLOGY DR",
            "address_2": "SUITE 11",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333472",
            "telephone_number": "631-444-4233",
            "fax_number": "631-444-3403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "FAZEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2014-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "252511-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "357146700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.