Gohar Shamshad Khan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME0029698 Issued in FL

Practice address

905 Beville Rd
South Daytona, FL 32119-1705

Phone

(386) 767-9000

Fax

(386) 767-3761

NPI assigned

Jun 17, 2005

Last updated

Feb 26, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sarina Healthcare LLC

  • Family Medicine Physician
  • South Daytona, FL
  • NPI 1831774264
  NPD

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1568467256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 BEVILLE RD",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321191705",
            "telephone_number": "386-767-9000",
            "fax_number": "386-767-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 BEVILLE RD",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321191705",
            "telephone_number": "386-767-9000",
            "fax_number": "386-767-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "GOHAR",
        "middle_name": "SHAMSHAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-17",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME0029698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067228900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lukia Kalibbala
• Christopher Scott Kapelka, PTA
• Jennifer Kelly, CD(DONA)
• Brittney Kerchief
• Asad Hamid Khan, MD
• Susan Rita Kicklighter, MSW
• Kim Kling LMT
• Amber Marie Kingsley, DC, DIBCN
• Marsha Lyn Klopfenstein
• Maimi Kobayashi

• Family Medicine Physician in South Daytona, FL
• Providers in South Daytona, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.