NPIMap

Individual provider Active NPI

Khaled Hammadi Janom, M.D.

  • Internal Medicine Physician
  • Detroit, MI
National Provider Identifier
1528592128
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M-16394 Issued in ID
Practice address
4201 St Antoine St, Uhc 9C
Detroit, MI 48201
Phone
(313) 745-4832
NPI assigned
Apr 20, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X M-16394 ID Primary

Addresses

Primary practice location

4201 St Antoine St, Uhc 9C
Detroit, MI 48201

Mailing address

4201 St. Antoine St, Uhc 9C
Detroit, MI 48201
Phone (313) 745-4832

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20220525000714 ID Practitioner - Internal Medicine 3375813363 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Idaho Kidney Institute LLPGroup PAC ID 9032155312, 14 clinicians

Practice addresses (Care Compare)

4511 Zebe Ave
Chubbuck, ID 83202-4707
Phone (208) 904-4780

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-16394IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Kidney Institute LLP Nephrology CurrentSince May 1, 2022 Accepting new patients
BMH, Inc. CurrentSince Jul 1, 2022 Accepting new patients
BMH, Inc. CurrentSince Jul 1, 2022 Accepting new patients
BMH, Inc. Internal Medicine Current Accepting new patients
Transtreme, LLC PastSince May 1, 2022 Accepting new patients

Locations

315 W Idaho St
Blackfoot, ID 83221
Phone (208) 782-3990

235 Poplar St
Blackfoot, ID 83221
Phone (208) 785-3828

98 Poplar St
Blackfoot, ID 83221
Phone (208) 782-3763

1501 Hiland Ave
Ste M
Burley, ID 83318
Phone (208) 352-7555

2381 E Sunnyside Rd
Idaho Falls, ID 83404
Phone (208) 523-8500

Interoperability endpoints

  • Direct secure messaging: kjanom709084@ahs.direct-ci.com

Organizations & group practices 5

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": "1492646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1528592128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ST. ANTOINE ST, UHC 9C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 ST ANTOINE ST, UHC 9C",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-4832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANOM",
        "first_name": "KHALED",
        "middle_name": "HAMMADI",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-20",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-16394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.