Jenna Khansa, TLLP

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

62 W 7 Mile Rd
Detroit, MI 48203-1967

Phone

(313) 893-6172

Fax

(313) 893-0064

NPI assigned

Sep 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Driven Minds Psychiatry, PLLC

  • Psychiatry Physician
  • Novi, MI
  • NPI 1457192064
  Medicare reassignment NPD
• Greenfield Medical Center

  • Family Medicine Physician
  • Dearborn, MI
  • NPI 1033387188
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1790203297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 W 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482031967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 W 7 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482031967",
            "telephone_number": "313-893-6172",
            "fax_number": "313-893-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANSA",
        "first_name": "JENNA",
        "credential": "TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301017190",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3434247",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suchit Khanduja, M.D
• Charanpreet Kaur Khangura, DO
• Raminder Kaur Khangura, M.D.
• Kanika Khanna, M.D
• Shyam Lal Khanna, M.D.
• Satish R Khanzode, M.D.
• Deepti Kharkar, PT
• Bella Zaynab Khatib-Shahidi, MD
• Hiba Khatib
• Baila Khatoon, MD

• Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.