Mohammad Ibraheem Khan, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

305306 Issued in NY

Practice address

Stony Brook Ufpc Practice 101 Nicolls Road HSC T17-060
Stony Brook, NY 11794-6999

Phone

(631) 444-3518

Fax

(631) 444-8886

NPI assigned

Apr 17, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, MD2 enrollments

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 2

Specialty

Gastroenterology

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Agnes Healthcare IncGroup PAC ID 9830092733, 265 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Agnes Hospital Hospital, Baltimore, MD, CCN 210011

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Agnes Healthcare Inc

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176
  Medicare reassignment Care Compare group NPD
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD

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

• St. Agnes Healthcare, Inc.

  • General Acute Care Hospital
  • Baltimore, MD
  • NPI 1245274901
  Care Compare affiliation

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1659791663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900989",
            "telephone_number": "631-444-3518",
            "fax_number": "631-444-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK UFPC PRACTICE 101 NICOLLS ROAD HSC T17-060",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117946999",
            "telephone_number": "631-444-3518",
            "fax_number": "631-444-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOHAMMAD",
        "middle_name": "IBRAHEEM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "305306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amaal Haleem Khan
• Asif Khan, DO
• Jansher Khan
• Laraib Khan, PHARMD
• Malik Hasnat Ul Hassan Khan
• Mustafa Ali Khan, MD
• Muzammil Khan, MD
• Redha Khan, DDS
• Sara Khan
• Sara Atiq Khan, M.D.

• Gastroenterology Physician in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.