Active NPI
Omar Ali Khan, M.D.
- Family Medicine Physician
- Roswell, NM
National Provider Identifier
1689864951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD2009-0771
- Practice address
- 300 W Country Club Rd
Suite # 220
Roswell, NM 88201-5202 - Phone
- (575) 625-1292
- NPI assigned
- Aug 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2007-0423 | NM | |
| Family Medicine Physician | 207Q00000X | MD2009-0771 | NM | Primary |
Addresses
Primary practice location
300 W Country Club Rd
Suite # 220
Roswell, NM 88201-5202
Mailing address
405 W Country Club Rd
C/O Mso Administration
Roswell, NM 88201-5209
Phone (575) 625-1292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| YIH843397355 | Other | NM | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007-0423 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roswell Clinic Corp | Family Medicine | Past | Accepting new patients |
| Roswell Clinic Corp | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Durable Medical Equipment & Medical Supplies
- Roswell, NM
- NPI 1396958633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295222400000",
"number": "1689864951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 W COUNTRY CLUB RD",
"address_2": "C/O MSO ADMINISTRATION",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882015209",
"telephone_number": "575-625-1292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W COUNTRY CLUB RD",
"address_2": "SUITE # 220",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882015202",
"telephone_number": "575-625-1292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "OMAR",
"middle_name": "ALI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-01",
"last_updated": "2011-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "2007-0423",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "MD2009-0771",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "YIH843397355",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.