NPIMap

Individual provider Active NPI

Ghulam Khan, MD

  • Family Medicine Physician
  • Pine Bluff, AR
National Provider Identifier
1588042220
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-10502 Issued in AR
Practice address
4010 S Mulberry St
Pine Bluff, AR 71603
Phone
(870) 541-6000
NPI assigned
May 14, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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 64115 CT
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X E-10502 AR Primary

Addresses

Primary practice location

4010 S Mulberry St
Pine Bluff, AR 71603

Mailing address

4010 S Mulberry St
Pine Bluff, AR 71603-7000
Phone (870) 541-6010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170501001318 AR Practitioner - Family PracticePractitioner - Emergency Medicine 0648557686 Reassigns benefits to 5 organizations
I20190911002444 CT Practitioner - Family PracticePractitioner - Emergency Medicine 0648557686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

22 Old Waterbury Rd
Southbury, CT 06488-3848
Phone (203) 262-4200

Hospital & facility affiliations

  • Western Connecticut Home Care Inc Home health agency, Danbury, CT, CCN 077088
  • Elara Caring Home health agency, Rocky Hill, CT, CCN 077163
  • Rvnahealth Home health agency, Ridgefield, CT, CCN 077066
  • Constellation Home Care Hospice, Norwalk, CT, CCN 071542
  • Vitas Healthcare Corporation Atlantic Hospice, Middlebury, CT, CCN 071533
  • Regional Hospice Hospice, Danbury, CT, CCN 071518
  • Danbury Hospital Hospital, Danbury, CT, CCN 070033
  • Griffin Hospital Hospital, Derby, CT, CCN 070031
  • Lutheran Home Of Southbury Inc Nursing home, Southbury, CT, CCN 075371

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-10502ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Care Consultants of Fordyce LLC CurrentSince May 31, 2017 Accepting new patients
Ess of Fordyce LLC CurrentSince May 31, 2017 Accepting new patients
Ess Hospitalist LLC CurrentSince Sep 1, 2017 Accepting new patients
Arkansas Emergency Staffing Solutions, Inc CurrentSince Sep 1, 2017 Accepting new patients
Nes Kentucky Inc CurrentSince Oct 31, 2017 Accepting new patients
Nuvance Health Medical Practice CT, Inc. Family Medicine CurrentSince Jan 6, 2020 Accepting new patients
Lutheran Home of Southbury Inc Past Accepting new patients

Locations

451 W Locke St
Ashdown, AR 71822
Phone (870) 265-5351

1015 Unity Rd
Crossett, AR 71635
Phone (870) 364-0590

201 N Clifton St
Fordyce, AR 71742
Phone (870) 352-6300

2729 S Highway 65 82
Lake Village, AR 71653
Phone (870) 265-5351

130 Medical Cir
Nashville, AR 71852
Phone (501) 624-7700

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

130 Division St
Derby, CT 06418
Phone (203) 732-1330

22 Old Waterbury Rd
Southbury, CT 06488
Phone (203) 262-4200

990 Main St N
Southbury, CT 06488
Phone (203) 264-9135

Interoperability endpoints

  • Direct secure messaging: ghulam.khan.p7@direct.dact.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lutheran Home of Southbury IncSouthbury, CT, CCN 075371 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2024
Jan 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 10

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": "1431561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1588042220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 S MULBERRY ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037000",
            "telephone_number": "870-541-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 S MULBERRY ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-541-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "GHULAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-14",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "64115",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-10502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.