Active NPI
Manoj P Khandheria, MD
- Urology Physician
- Lubbock, TX
National Provider Identifier
1861506669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- G4324
- Practice address
- 2424 50TH St RM 301
Lubbock, TX 79412-2561 - Phone
- (806) 795-2533
- Fax
- (806) 795-0336
- NPI assigned
- Aug 18, 2006
- Last updated
- Jul 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | G4324 | TX | Primary |
Addresses
Primary practice location
2424 50TH St RM 301
Lubbock, TX 79412-2561
Mailing address
PO Box 64056
Lubbock, TX 79464-4056
Phone (806) 795-2533
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 097789402 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, VI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Governor Juan F. Luis Hospital & Medical Center | Current | Accepting new patients | |
| Governor Juan F. Luis Hospital & Medical Center | Current | Accepting new patients |
Locations
4007 Estate Diamond Ruby
St Croix, VI 00820
Phone (340) 772-7423
Interoperability endpoints
- mkhandher@yourcarecommunity.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Acute Care Hospital
- Christiansted, St. Croix, VI
- NPI 1972503647
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- St Croix, VI
- NPI 1740238534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278547200000",
"number": "1861506669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 64056",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794644056",
"telephone_number": "806-795-2533",
"fax_number": "806-795-0336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2424 50TH ST RM 301",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794122561",
"telephone_number": "806-795-2533",
"fax_number": "806-795-0336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANDHERIA",
"first_name": "MANOJ",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2010-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "TX",
"license": "G4324",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "097789402",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.