Individual provider Active NPI

Tawan Sunny Khamapirad, M.D.

  • Ophthalmology Physician
  • Memphis, TN
National Provider Identifier
1689679441
Registry record updated Apr 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
37817 Issued in TN
Practice address
6005 Park Ave
Ste 624B
Memphis, TN 38119-5221
Phone
(901) 682-1100
Fax
(901) 682-6915
NPI assigned
Jun 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 37817 TN Primary
Ophthalmology Physician 207W00000X 18267 MS
Ophthalmology Physician 207W00000X E3846 AR
Retina Specialist (Ophthalmology) Physician 207WX0107X 18267 MS
Retina Specialist (Ophthalmology) Physician 207WX0107X E3846 AR
Retina Specialist (Ophthalmology) Physician 207WX0107X 37817 TN

Addresses

Primary practice location

6005 Park Ave
Ste 624B
Memphis, TN 38119-5221

Mailing address

PO Box 1000 Dept 448
Memphis, TN 38148-0448
Phone (901) 682-1100

Other identifiers 3

IdentifierTypeStateIssuer
4067262OtherTNBLUE CROSS
04635763MedicaidMS
3886759MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 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

Enrollment IDStateProvider typePAC IDDetails
I20060927000127 MS Practitioner - Ophthalmology 6002806627 Reassigns benefits to 1 organization
I20080204000312 TN Practitioner - Ophthalmology 6002806627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid South Retina Associates, LLCGroup PAC ID 8921080094, shared by 3 NPIs, 6 clinicians

Practice addresses (Care Compare)

201 Alcorn Dr
Corinth, MS 38834-8400
Phone (662) 287-7111

328 Coatsland Dr
Jackson, TN 38301-3908
Phone (731) 427-1476

6005 Park Ave
Suite 624
Memphis, TN 38119-5202
Phone (901) 682-1100

Hospital & facility affiliations

  • Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E3846ARMDRetina Specialist (Ophthalmology) Physician
18267MSMDRetina Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-South Retina Associates, LLC Ophthalmology CurrentSince Sep 1, 2003 Accepting new patients
Mid South Retina Associates, LLC Ophthalmology Current Accepting new patients
Mid South Retina Associates LLC Ophthalmology CurrentSince Sep 1, 2003 Accepting new patients

Locations

533 N 10th St
Blytheville, AR 72315
Phone (870) 762-1942

529 N 10th St
Blytheville, AR 72315
Phone (870) 762-1942

201 Alcorn Dr
Ste 2D
Corinth, MS 38834

201 Alcorn Dr
Corinth, MS 38834
Phone (662) 286-3277

328 Coatsland Dr
Jackson, TN 38301
Phone (731) 427-1476

6005 Park Ave
Ste 624B
Memphis, TN 38119
Phone (901) 682-1100

Interoperability endpoints

  • Direct secure messaging: tkhamapirad@msra.intellechartdirect.net

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.

Hospital & facility affiliations 1

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1689679441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000 DEPT 448",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480448",
            "telephone_number": "901-682-1100",
            "fax_number": "901-682-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 PARK AVE",
            "address_2": "STE 624B",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195221",
            "telephone_number": "901-682-1100",
            "fax_number": "901-682-6915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAMAPIRAD",
        "first_name": "TAWAN",
        "middle_name": "SUNNY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "37817",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MS",
            "license": "18267",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AR",
            "license": "E3846",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MS",
            "license": "18267",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "AR",
            "license": "E3846",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "TN",
            "license": "37817",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4067262",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04635763",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3886759",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.