NPIMap

Individual provider Active NPI

Ayaz M Khan, M.D.

  • Addiction Medicine (Anesthesiology) Physician
  • Williamsport, PA
National Provider Identifier
1629052188
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Anesthesiology) PhysicianTaxonomy code 207LA0401X
License
MD435280 Issued in PA
Practice address
553 E 3Rd St
Pain Management of Williamsport
Williamsport, PA 17701-5316
Phone
(570) 323-3106
Fax
(570) 323-3606
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X MD435280 PA
Anesthesiology Physician 207L00000X 002185 NY
Addiction Medicine (Anesthesiology) Physician 207LA0401X MD435280 PA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 251006 NY

Addresses

Primary practice location

553 E 3Rd St
Pain Management of Williamsport
Williamsport, PA 17701-5316

Mailing address

553 E 3Rd St
Pain Management of Williamsport,LLC
Williamsport, PA 17701-5316
Phone (570) 323-3106

Other identifiers 1

IdentifierTypeStateIssuer
1629052188OtherNPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121017000642 PA Practitioner - AnesthesiologyPractitioner - Interventional Pain ManagementPractitioner - Pain ManagementPractitioner - Addiction Medicine 4385610021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Addiction Medicine, Interventional Pain Management, Pain Management
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

427 Hepburn St
Williamsport, PA 17701-6122
Phone (570) 323-3106

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
251006NYMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Management of Williamsport, LLC CurrentSince Aug 1, 2012 Accepting new patients
Residential Home Health of NC PA, LLC Past Accepting new patients

Locations

427 Hepburn St
Williamsport, PA 17701
Phone (570) 323-3106

553 E 3rd St
Williamsport, PA 17701
Phone (570) 323-3106

Organizations & group practices 2

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.

Hospital & facility affiliations 33

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1629052188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 E 3RD ST",
            "address_2": "PAIN MANAGEMENT OF WILLIAMSPORT,LLC",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015316",
            "telephone_number": "570-323-3106",
            "fax_number": "570-323-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "553 E 3RD ST",
            "address_2": "PAIN MANAGEMENT OF WILLIAMSPORT",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015316",
            "telephone_number": "570-323-3106",
            "fax_number": "570-323-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "AYAZ",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD435280",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "002185",
            "primary": false
        },
        {
            "code": "207LA0401X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "PA",
            "license": "MD435280",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "251006",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629052188",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.