NPIMap

Individual provider Active NPI

Nami Khulusi, M.D.

  • Internal Medicine Physician
  • Eatontown, NJ
National Provider Identifier
1841361771
Registry record updated Nov 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06313900 Issued in NJ
Practice address
615 Hope Rd
BLDG 2a
Eatontown, NJ 07724-1277
Phone
(848) 456-4485
Fax
(848) 456-4492
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06313900 NJ Primary

Addresses

Primary practice location

615 Hope Rd
BLDG 2a
Eatontown, NJ 07724-1277

Mailing address

615 Hope Rd
BLDG 2a
Eatontown, NJ 07724
Phone (848) 456-4485

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051006000156 NJ Practitioner - Internal Medicine 4082639323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

615 Hope Rd
Suite 2a
Eatontown, NJ 07724-1273
Phone (848) 456-4982

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06313900NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nami Khulusi MD LLC Internal Medicine CurrentSince Oct 1, 2006 Accepting new patients
Marron Family Wellness Center LLC CurrentSince Feb 24, 2022 Accepting new patients
Internal Medicine Associates of Monmouth, PC Internal Medicine PastSince Jul 2, 2002 Accepting new patients
Jack Gold Surgical Appliances, Inc. Past Accepting new patients
Barnabas Health Medical Group, PC Internal Medicine Past Accepting new patients

Locations

615 Hope Rd
Ste 2A
Eatontown, NJ 07724
Phone (732) 233-6448

74 Route 9
Lowr
Englishtown, NJ 07726
Phone (732) 972-5880

300 2nd Ave
Long Branch, NJ 07740
Phone (732) 222-5200

Interoperability endpoints

  • Direct secure messaging: nami.khulusi.1@14511.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 10

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1841361771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 HOPE RD",
            "address_2": "BLDG 2A",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "07724",
            "telephone_number": "848-456-4485",
            "fax_number": "848-456-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 HOPE RD",
            "address_2": "BLDG 2A",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241277",
            "telephone_number": "848-456-4485",
            "fax_number": "848-456-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHULUSI",
        "first_name": "NAMI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06313900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

Verify at the official NPI Registry.