Individual provider Active NPI

George Khoudari, MD

  • Gastroenterology Physician
  • Port St Lucie, FL
National Provider Identifier
1578978995
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
ME168343 Issued in FL
Practice address
10050 SW Innovation Way
Port St Lucie, FL 34987-2117
Phone
(772) 223-5945
Fax
(772) 345-5365
NPI assigned
Jun 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.131927 OH
Gastroenterology Physician 207RG0100X ME168343 FL Primary

Addresses

Primary practice location

10050 SW Innovation Way
Port St Lucie, FL 34987-2117

Mailing address

10050 SW Innovation Way
Port St Lucie, FL 34987-2117
Phone (772) 223-5945

Other practice location 1

3800 Reservoir Rd NW
Washington, DC 20007-2113
Phone (202) 444-2855

Other practice location 2

9500 Euclid Ave
Cleveland, OH 44195-4122
Phone (216) 446-0346

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240821004906 FL Practitioner - Gastroenterology 4284908682 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10000 SW Innovation Way
Port Saint Lucie, FL 34987-2111
Phone (772) 345-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.26 of 100Reported as apm
Quality
80.2
Promoting interoperability
99.24
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy85
Upper gastrointestinal (GI) endoscopy for acid reflux95

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Martin Memorial Medical Center Inc CurrentSince Jan 1, 2025 Accepting new patients

Locations

10050 SW Innovation Way
Port St Lucie, FL 34987
Phone (772) 344-3811

10000 SW Innovation Way
Port St Lucie, FL 34987
Phone (772) 288-5853

200 SE Hospital Ave
Stuart, FL 34994
Phone (772) 223-5618

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

9500 Euclid Ave
#M8
Cleveland, OH 44195

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 1

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 3

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1578978995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 SW INNOVATION WAY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872117",
            "telephone_number": "772-223-5945",
            "fax_number": "772-345-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 SW INNOVATION WAY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872117",
            "telephone_number": "772-223-5945",
            "fax_number": "772-345-5365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Reservoir Rd NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200072113",
            "country_code": "US",
            "telephone_number": "202-444-2855",
            "fax_number": "877-303-1462",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441954122",
            "country_code": "US",
            "telephone_number": "216-446-0346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOUDARI",
        "first_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.131927",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME168343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.