Khaled R Hassan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2002013702 Issued in MO

Practice address

12800 Boenker LN
Bridgeton, MO 63044-2438

Phone

(314) 551-0338

Fax

(314) 551-0336

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Advanced Medical Associates, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1275705501
  NPD (past)
• Tenet Healthsystem Di, Inc.

  dba Des Peres Hospital

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1104857994
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1841303310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12800 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442438",
            "telephone_number": "314-551-0338",
            "fax_number": "314-551-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442438",
            "telephone_number": "314-551-0338",
            "fax_number": "314-551-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASSAN",
        "first_name": "KHALED",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2002013702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209188721",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruth Esther Hartstack, BA
• Dinah Hartwell, MSW
• Shahzad Hasan, MD
• Teresa Anne Hasik, RN, BSN
• Eve Lynn Haskell, M.A.
• Kelly Lyn Hatina
• Bonnie Beth Hauenstein, R.D., L.D.
• Judith M. Haug, LCSW
• Allison Haungs, M.D.
• Samantha Hauser

• Internal Medicine Physician in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; 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.

Verify at the official NPI Registry.