Individual provider Active NPI

Omar Kamaal Khalique, MD

  • Cardiovascular Disease Physician
  • New York, NY
National Provider Identifier
1629376850
Registry record updated Jun 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
260639-1 Issued in NY
Practice address
622 W 168TH St
New York, NY 10032-3720
Phone
(212) 342-3616
Fax
(212) 342-3640
NPI assigned
Mar 11, 2011
Last updated
Jun 14, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 260639-1 NY Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X 260639 NY

Addresses

Primary practice location

622 W 168TH St
New York, NY 10032-3720

Mailing address

630 W 168TH St
Box 4
New York, NY 10032-3725
Phone (212) 342-3616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20120614000501 NY Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Cardiac Electrophysiology 6002070463 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians
St Francis Cardiac Prevention Services PCGroup PAC ID 4183515836, 60 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 562-6000

2200 Northern Blvd
100C St Francis Diagnostic
Greenvale, NY 11548-1220
Phone (516) 325-7400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
260639-1NYMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, P.C Cardiovascular Disease CurrentSince Jan 11, 2022 Accepting new patients
St. Francis Cardiac Prevention Services PC CurrentSince Jan 11, 2022 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jul 23, 2012 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Feb 25, 2019 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 1, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 1, 2015 Accepting new patients
Columbiadoctors/Newyork-Presbyterianimaging CurrentSince Feb 25, 2019 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 1, 2015 Accepting new patients
Trustees Columbia University City Ny Center Interventional Vascular TH Past Accepting new patients

Locations

2460 Mickle Ave
Bronx, NY 10469
Phone (718) 424-3131

2200 Northern Blvd
Greenvale, NY 11548
Phone (516) 325-7310

2200 Northern Blvd
Ste 100C
Greenvale, NY 11548
Phone (516) 325-7400

2200 Northern Blvd
Ste 118
Greenvale, NY 11548
Phone (516) 563-7910

4 Ohio Dr
New Hyde Park, NY 11042
Phone (516) 519-8260

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

161 Fort Washington Ave
Fl 5
New York, NY 10032
Phone (212) 305-4000

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

622 W 168th St
#4100
New York, NY 10032
Phone (212) 305-5123

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 11

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 5

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": "1299801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497398400000",
    "number": "1629376850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST",
            "address_2": "BOX 4",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-342-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-342-3616",
            "fax_number": "212-342-3640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIQUE",
        "first_name": "OMAR",
        "middle_name": "KAMAAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-11",
        "last_updated": "2017-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "260639-1",
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NY",
            "license": "260639",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.