Individual provider Active NPI

Hamid-U-Rahman Khalili, ARNP

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1609194653
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9251167 Issued in FL
Practice address
5045 Soutel Dr Ste 12
Ufjax - Soutel Plaza Family Practice
Jacksonville, FL 32208-1885
Phone
(904) 633-0500
Fax
(904) 633-0441
NPI assigned
May 13, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9251167 FL Primary

Addresses

Primary practice location

5045 Soutel Dr Ste 12
Ufjax - Soutel Plaza Family Practice
Jacksonville, FL 32208-1885

Mailing address

PO Box 44008
Ufjp - Provider Enrollment
Jacksonville, FL 32231-4008
Phone (904) 244-3199

Other identifiers 1

IdentifierTypeStateIssuer
0031248-00MedicaidFL

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110303000680 FL Practitioner - Nurse Practitioner 0042492613 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

1833 Boulevard Ave
Jacksonville, FL 32206-4394
Phone (904) 383-1040

Hospital & facility affiliations

  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Merit-based Incentive Payment System (MIPS)

Final score
59.59 of 100Reported as apm
Quality
59.93
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians Inc Current Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jan 31, 2011 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Jan 31, 2011 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Feb 1, 2014 Accepting new patients

Locations

5045 Soutel Dr
Ste 12
Jacksonville, FL 32208
Phone (904) 633-0500

1255 Lila St
Jacksonville, FL 32208
Phone (904) 244-5700

1833 Boulevard
Jacksonville, FL 32206
Phone (904) 244-3289

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

Interoperability endpoints

  • Direct secure messaging: hkhalili37203@direct.shands.ufl.edu

Organizations & group practices 4

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 2

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": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1609194653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44008",
            "address_2": "UFJP - PROVIDER ENROLLMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314008",
            "telephone_number": "904-244-3199",
            "fax_number": "904-244-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 SOUTEL DR STE 12",
            "address_2": "UFJAX - SOUTEL PLAZA FAMILY PRACTICE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322081885",
            "telephone_number": "904-633-0500",
            "fax_number": "904-633-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALILI",
        "first_name": "HAMID-U-RAHMAN",
        "name_prefix": "Mr.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-13",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9251167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031248-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.