Individual provider Active NPI

Khalida Qalbani, MD

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1659322287
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004002967 Issued in MO
Practice address
5535 Delmar Boulevard
Saint Louis, MO 63112-3005
Phone
(314) 361-2273
Fax
(314) 879-6372
NPI assigned
May 16, 2006
Last updated
Dec 16, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004002967 MO Primary

Addresses

Primary practice location

5535 Delmar Boulevard
Saint Louis, MO 63112-3005

Mailing address

5535 Delmar Boulevard
Saint Louis Connectcare
Saint Louis, MO 63112-3005
Phone (314) 879-6309

Other identifiers 2

IdentifierTypeStateIssuer
209353903MedicaidMO
11462947MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20140627001215 MO Order and Referring Only - Family PracticePractitioner - Family Practice 5395797484

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004002967MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Louis Connectcare Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1659322287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 DELMAR BOULEVARD",
            "address_2": "SAINT LOUIS CONNECTCARE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123005",
            "telephone_number": "314-879-6309",
            "fax_number": "314-879-6372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 DELMAR BOULEVARD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631123005",
            "telephone_number": "314-361-2273",
            "fax_number": "314-879-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QALBANI",
        "first_name": "KHALIDA",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004002967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209353903",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11462947",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.