Mudussara Asad Khan, MD

Primary specialty

Medical Oncology PhysicianTaxonomy code 207RX0202X

License

ME114473 Issued in FL

Practice address

224 Memorial Medical Pkwy
Suite 300
Daytona Beach, FL 32117-5122

Phone

(386) 231-4060

Fax

(386) 615-9119

NPI assigned

Jun 5, 2007

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hematology/Oncology

Education

Barnes Medical College, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Cancer Specialists and Research Institute, LLCGroup PAC ID 2567356058, 464 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
• Adventhealth New Smyrna Beach Hospital, New Smyrna Beach, FL, CCN 100014
• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Cape Coral, FL
  • NPI 1760590962

  Hematology

  Medicare reassignment Care Compare group NPD
• Florida Cancer Specialists & Research Institute, LLC

  • Hematology & Oncology Physician
  • Daytona Beach, FL
  • NPI 1063815421
  NPD (past)
• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Bradenton, FL
  • NPI 1508973231

  Hematology

  NPD (past)
• SRMC Healthcare Group LLC

  • Clinical Pathology/Laboratory Medicine Physician
  • Waynesburg, PA
  • NPI 1861424525
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventhealth Palm Coast Parkway Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Memorial Health Systems Inc

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1063426823
  Care Compare affiliation
• Memorial Health Systems Inc

  • Clinical Medical Laboratory
  • Daytona Beach, FL
  • NPI 1104696178

  Hospital

  Care Compare affiliation
• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation
• Southeast Volusia Healthcare Corporation

  • General Acute Care Hospital
  • New Smyrna Beach, FL
  • NPI 1871977942
  Care Compare affiliation

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1821290362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "address_2": "ATTN: CREDENTIALING DEPT.",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200",
            "fax_number": "239-278-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 MEMORIAL MEDICAL PKWY",
            "address_2": "SUITE 300",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175122",
            "telephone_number": "386-231-4060",
            "fax_number": "386-615-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MUDUSSARA",
        "middle_name": "ASAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "FL",
            "license": "ME114473",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "FL",
            "license": "ME114473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008708200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sepeedeh Zahra Kermalli, DO
• J Patrick Kerr, CRNA
• Jeanne Marie Kerr, MSN APRN NP-C
• Jennifer Ketring, LCSW
• Abdus Salam Khan, MD
• Omar Khan
• Lyndi Khanna, APRN
• Rohit Kumar Khanna, MD
• Sohit K Khanna, M.D.
• Harish Kher, MD

• Medical Oncology Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Medical Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.