NPIMap

Individual provider Active NPI

Tariq A. Khan, M.D.

  • Internal Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1700846169
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12962R Issued in LA
Practice address
1717 Oak Park Blvd
3Rd FL
Lake Charles, LA 70601-8991
Phone
(337) 475-8100
Fax
(337) 475-8510
NPI assigned
Mar 27, 2006
Last updated
Jun 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12962R LA Primary

Addresses

Primary practice location

1717 Oak Park Blvd
3Rd FL
Lake Charles, LA 70601-8991

Mailing address

PO Box 122108
Dept 2108
Dallas, TX 75312-2108
Phone (337) 475-8100

Other identifiers 1

IdentifierTypeStateIssuer
1670936MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110121000402 LA Practitioner - Internal Medicine 6507045622 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Louisiana Physicians, LLCGroup PAC ID 7315396355, 17 clinicians

Practice addresses (Care Compare)

524 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5725
Phone (337) 436-2511

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12962RLAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Emergency Medicine Management -- Lake Charles LLC CurrentSince Jun 1, 2019 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Jun 7, 2019 Accepting new patients
Southwest Louisiana Physicians, LLC Internal Medicine CurrentSince Feb 1, 2024 Accepting new patients
Cogent Healthcare of Texas, PA Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Christus Health Southwestern Louisiana Past Accepting new patients

Locations

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

4200 Nelson Rd
Lake Charles, LA 70605
Phone (318) 474-6370

524 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 430-4455

2000 Canal St
#C
New Orleans, LA 70112

1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1700846169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122108",
            "address_2": "DEPT 2108",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122108",
            "telephone_number": "337-475-8100",
            "fax_number": "337-475-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OAK PARK BLVD",
            "address_2": "3RD FL",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018991",
            "telephone_number": "337-475-8100",
            "fax_number": "337-475-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "TARIQ",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "12962R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1670936",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.