NPIMap

Individual provider Active NPI

Merieme Khamsi, PA

  • Surgical Physician Assistant
  • Surprise, AZ
National Provider Identifier
1720597214
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
14674 W Mountain View Blvrd #210
Surprise, AZ 85374
Phone
(915) 581-1395
NPI assigned
Sep 27, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

14674 W Mountain View Blvrd #210
Surprise, AZ 85374

Mailing address

14674 W Mountain View Blvrd #210,
Suprise, AZ 85374
Phone (623) 546-1400

Other practice location 1

14674 W Mountain View Blvrd #210
Surprise, AZ 85374
Phone (915) 581-1395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200325000964 TX Practitioner - Physician Assistant 5698031318 Reassigns benefits to 1 organization
I20210803002210 OH Practitioner - Physician Assistant 5698031318 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

158 W Main Rd
Conneaut, OH 44030-2039

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Aug 14, 2022 Accepting new patients
Uh Regional Hospitals CurrentSince Jun 21, 2021 Accepting new patients
Cook Children's Physician Network CurrentSince Mar 16, 2020 Accepting new patients
Uh Regional Hospitals Physician Assistant CurrentSince Jun 21, 2021 Accepting new patients
University Primary Care Practices Inc CurrentSince Aug 14, 2022 Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

3315 N Ridge Rd E
Ste 700A
Ashtabula, OH 44004
Phone (440) 484-2130

8819 Quincy Ave
Ste 206
Cleveland, OH 44106
Phone (440) 623-7781

11100 Euclid Ave
Cleveland Heights, OH 44106

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

1500 Cooper St
Ft Worth, TX 76104
Phone (682) 885-2500

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

136 El Chico Trl
Ste 102
Willow Park, TX 76087
Phone (817) 441-5412

Interoperability endpoints

  • Direct secure messaging: mkhamsi28417@ehrdirect.uhhospitals.org

Organizations & group practices 9

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 6

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": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1720597214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14674 W MOUNTAIN VIEW BLVRD #210,",
            "city": "SUPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "623-546-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14674 W MOUNTAIN VIEW BLVRD #210",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "915-581-1395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14674 W Mountain View Blvrd #210",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "85374",
            "country_code": "US",
            "telephone_number": "915-581-1395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAMSI",
        "first_name": "MERIEME",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

Verify at the official NPI Registry.