NPIMap

Individual provider Active NPI

Farah Khan, MD

  • Family Medicine Physician
  • Deforest, WI
National Provider Identifier
1508153867
Registry record updated Mar 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
65053 Issued in WI
Practice address
4200 Savannah Dr
Deforest, WI 53532-2909
Phone
(608) 417-3300
Fax
(608) 417-3333
NPI assigned
Jul 6, 2011
Last updated
Mar 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2014-00863 NC
Family Medicine Physician 207Q00000X P4068 TX
Family Medicine Physician 207Q00000X 65053 WI Primary

Addresses

Primary practice location

4200 Savannah Dr
Deforest, WI 53532-2909

Mailing address

202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20160419002414 WI Practitioner - Family Practice 1254504590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meriter Hospital IncGroup PAC ID 3971412735, 122 clinicians

Practice addresses (Care Compare)

202 S Park St
Madison, WI 53715-1507
Phone (608) 417-6000

3102 Meriter Way
Madison, WI 53719-5833
Phone (608) 417-8800

4200 Savannah Dr
De Forest, WI 53532-2909
Phone (608) 417-3300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2014-00863NCMDFamily Medicine Physician
P4068TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Meriter Hospital, Inc. Current Accepting new patients
Meriter Hospital, Inc. CurrentSince Apr 1, 2016 Accepting new patients
Meriter Hospital, Inc. Past Accepting new patients

Locations

4200 Savannah Dr
Deforest, WI 53532
Phone (608) 417-3300

202 S Park St
Madison, WI 53715
Phone (608) 267-6000

3102 Meriter Way
Madison, WI 53719
Phone (608) 417-8800

Interoperability endpoints

  • Direct secure messaging: fkhan400164@direct.unitypoint.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1508153867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151507",
            "telephone_number": "608-417-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 SAVANNAH DR",
            "city": "DEFOREST",
            "state": "WI",
            "postal_code": "535322909",
            "telephone_number": "608-417-3300",
            "fax_number": "608-417-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "FARAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-06",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2014-00863",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4068",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "65053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deforest, WI

Sources for this page

Verify at the official NPI Registry.