Active NPI
Syed A Khasimuddin, M.D.
- Internal Medicine Physician
- Woodland, CA
National Provider Identifier
1720008212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A87340
- Practice address
- 632 W Gibson Rd
Woodland, CA 95695-5169 - Phone
- (530) 662-3961
- Fax
- (530) 756-5817
- NPI assigned
- Jul 20, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A87340 | CA | Primary |
Addresses
Primary practice location
632 W Gibson Rd
Woodland, CA 95695-5169
Mailing address
632 W Gibson Rd
Woodland, CA 95695-5169
Phone (530) 662-3961
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A873400 | Other | CA | BLUE SHIELD |
| 00A873400 | Medicaid | CA | |
| P00284490 | Other | CA | RR MEDICARE |
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 |
|---|---|---|---|
| A87340 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| House Physician Partners, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247702400000",
"number": "1720008212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 W GIBSON RD",
"city": "WOODLAND",
"state": "CA",
"postal_code": "956955169",
"telephone_number": "530-662-3961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 W GIBSON RD",
"city": "WOODLAND",
"state": "CA",
"postal_code": "956955169",
"telephone_number": "530-662-3961",
"fax_number": "530-756-5817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHASIMUDDIN",
"first_name": "SYED",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2009-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A87340",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00A873400",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A873400",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00284490",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.