Active NPI
Siddiqa K Khan, MD
- Family Medicine Physician
- Jacksonville, FL
National Provider Identifier
1740289180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 90990
- Practice address
- 1833 Boulevard
VA Outpatient Clinic
Jacksonville, FL 32206-4382 - Phone
- (904) 232-2751
- Fax
- (904) 301-2502
- NPI assigned
- Jul 19, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 90990 | FL | Primary |
Addresses
Primary practice location
1833 Boulevard
VA Outpatient Clinic
Jacksonville, FL 32206-4382
Mailing address
1833 Boulevard
Jaclsonville VA Outpatient Clinic
Jacksonville, FL 32206-4382
Phone (904) 232-2751
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3164176 | Other | FL | CIGNA |
| 392117 | Other | FL | HEALTHEASE |
| 2785404-00 | Medicaid | FL | |
| 298827 | Other | FL | AV MED |
| 2064269 | Other | FL | FIRST COAST ADVANTAGE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110504000355 | FL | Practitioner - Family Practice | 8426084617 | Practice locations: Jacksonville, FL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90990 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302134400000",
"number": "1740289180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1833 BOULEVARD",
"address_2": "JACLSONVILLE VA OUTPATIENT CLINIC",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322064382",
"telephone_number": "904-232-2751",
"fax_number": "904-301-2502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1833 BOULEVARD",
"address_2": "VA OUTPATIENT CLINIC",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322064382",
"telephone_number": "904-232-2751",
"fax_number": "904-301-2502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "SIDDIQA",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-19",
"last_updated": "2011-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "90990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3164176",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHEASE",
"identifier": "392117",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2785404-00",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AV MED",
"identifier": "298827",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST COAST ADVANTAGE",
"identifier": "2064269",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.