Individual provider Active NPI

Krishna Prasad Khanal, MBBS MD CAQSM FAAFP

  • Family Medicine Physician
  • Montrose, NY
National Provider Identifier
1679708234
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
S3832 Issued in TX
Practice address
2094 Albany Post Rd
Building # 3
Montrose, NY 10548-1454
Phone
(914) 737-4400
Fax
(845) 452-6516
NPI assigned
May 26, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39700 IA
Sports Medicine (Family Medicine) Physician 207QS0010X 275691 NY
Sports Medicine (Family Medicine) Physician 207QS0010X A 121654 CA
Sports Medicine (Family Medicine) Physician 207QS0010X 036.130459 IL
Sports Medicine (Family Medicine) Physician 207QS0010X S3832 TX
Family Medicine Physician 207Q00000X S3832 TX Primary

Addresses

Primary practice location

2094 Albany Post Rd
Building # 3
Montrose, NY 10548-1454

Mailing address

1901 Veteran Memorial Dr
Building # 163
Temple, TX 76504
Phone (800) 423-2111

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
I20150520001059 NY Practitioner - Family PracticePractitioner - Sports Medicine 1557530037 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S3832TXMDFamily Medicine Physician
A 121654CAMDSports Medicine (Family Medicine) Physician
036.130459ILMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Services of New York, P.C. CurrentSince Oct 1, 2016 Accepting new patients
Eastern Iowa Health Center Past Accepting new patients
Eastern Iowa Health Center Family Medicine Past Accepting new patients

Locations

2209 Genesee St
Utica, NY 13501
Phone (315) 798-8100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1679708234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 VETERAN MEMORIAL DR",
            "address_2": "BUILDING # 163",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "76504",
            "telephone_number": "800-423-2111",
            "fax_number": "254-743-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2094 ALBANY POST RD",
            "address_2": "BUILDING # 3",
            "city": "MONTROSE",
            "state": "NY",
            "postal_code": "105481454",
            "telephone_number": "914-737-4400",
            "fax_number": "845-452-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANAL",
        "first_name": "KRISHNA",
        "middle_name": "PRASAD",
        "name_prefix": "Dr.",
        "credential": "MBBS MD CAQSM FAAFP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "39700",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "275691",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "A 121654",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036.130459",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "S3832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S3832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montrose, NY

Sources for this page

Verify at the official NPI Registry.