Shishir Kumar Khetan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

73702 Issued in CT

Practice address

1201 Seven Locks Rd
Ste 111
Rockville, MD 20854-2957

Phone

(301) 762-5020

Fax

(301) 294-7569

NPI assigned

Jun 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in DC, TX, GA, FL, MT, TN, WA, OH, AZ9 enrollments

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 9

Specialty

Internal Medicine

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Tennessee LLCGroup PAC ID 0547667552, 141 clinicians

Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Privia Care Center LLCGroup PAC ID 3274801139, 286 clinicians

Health First Privia Medical GroupGroup PAC ID 3173965993, 247 clinicians

Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
• Direct secure messaging: shishir.khetan.1@8042.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/25095/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/28594/brand/1/csg/1/fhir/r4
• Direct secure messaging: shishir.khetan.1@28594.direct.athenahealth.com
• Direct secure messaging: shishir.khetan.1@26020.direct.athenahealth.com

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.

• Privia Care Center LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1164874426

  DC

  Medicare reassignment Care Compare group NPD
• Privia Medical Group Florida, LLC

  • General Practice Physician
  • Indialantic, FL
  • NPI 1700649043

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Tennessee LLC

  • Family Medicine Physician
  • Nashville, TN
  • NPI 1376110858

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment Care Compare group NPD
• Great Falls Clinic LLC

  • Multi-Specialty Clinic/Center
  • Great Falls, MT
  • NPI 1801897780
  Medicare reassignment NPD
• Oh Independent Medical Group LLC

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1497482111
  Medicare reassignment NPD
• Privia Medical Group Washington, PLLC

  • Clinic/Center
  • Walla Walla, WA
  • NPI 1780658419
  Medicare reassignment NPD
• Privia Medical Group West Texas, PLLC

  • Specialist
  • Abilene, TX
  • NPI 1346242567
  Medicare reassignment NPD
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  Medicare reassignment
• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment
• Privia Care Center LLC

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1730664012
  NPD

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1861497372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 79632",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212790632",
            "telephone_number": "301-762-5020",
            "fax_number": "301-309-3783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SEVEN LOCKS RD",
            "address_2": "STE 111",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208542957",
            "telephone_number": "301-762-5020",
            "fax_number": "301-294-7569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6450 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Rockledge",
            "state": "FL",
            "postal_code": "329555747",
            "country_code": "US",
            "telephone_number": "321-434-1512",
            "fax_number": "321-434-5485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHETAN",
        "first_name": "SHISHIR",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME148198",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0061630",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "73702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "416410500",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE HF",
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anchal Khanna, MS, LCMFT
• Srotalina Nayak Khanna, D.D.S.
• Kharod France PHD and Associates
• Nessrin Khaskia, M.S., CCC-A
• Noora Khattab
• Konstantin A Khludenev, MD
• Priyanka Khole
• Salma Kholousy
• Seunghee Ki, L.AC , PTA
• Felicity Kibaya

• Internal Medicine Physician in Rockville, MD
• Providers in Rockville, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; 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.