Khaled Ali Qasem, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

025816 Issued in GA

Practice address

3073 Dunn St SE
Smyrna, GA 30080-4470

Phone

(478) 892-3189

Fax

(478) 892-3189

NPI assigned

Apr 13, 2007

Last updated

Jun 14, 2012By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

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.

• Murray Medical Center, Inc.

  • General Acute Care Hospital
  • Chatsworth, GA
  • NPI 1972600211
  NPD (past)

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339632000000",
    "number": "1568686145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3073 DUNN ST SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804470",
            "telephone_number": "478-892-3189",
            "fax_number": "478-892-3189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 DUNN ST SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300804470",
            "telephone_number": "478-892-3189",
            "fax_number": "478-892-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QASEM",
        "first_name": "KHALED",
        "middle_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2012-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "025816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00275195A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PT Solutions of Acworth, LLC
• Publix Super Markets Inc (Publix Pharmacy #1250)
• Publix Super Markets Inc (Publix Pharmacy #0753)
• Joanne M Pulley, MS, LPC
• Ravi Pulusu
• Quantum Medical Radiology PC
• Quarells Consulting, P.C.
• Carlton Lee Quarells, PSY D
• Queen of Hearts Cosmetics
• Monique Query, DPT

• General Practice Physician in Smyrna, GA
• Providers in Smyrna, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; 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.