NPIMap

Individual provider Active NPI

Khaled Imam

  • Geriatric Medicine (Internal Medicine) Physician
  • Royal Oak, MI
National Provider Identifier
1902865454
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
4301047866 Issued in MI
Practice address
3535 W 13 Mile Rd
Ste. 108
Royal Oak, MI 48073-6710
Phone
(248) 551-1756
NPI assigned
Mar 22, 2006
Last updated
Oct 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 4301047866 MI Primary

Addresses

Primary practice location

3535 W 13 Mile Rd
Ste. 108
Royal Oak, MI 48073-6710

Mailing address

130 Town Center Dr Ste 203
Troy, MI 48084-1744

Other identifiers 2

IdentifierTypeStateIssuer
110F376980OtherMIBCBSM
2947749MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kimam8111@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20100215000743 MI Practitioner - Geriatric Medicine 3375687338 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
William Beaumont HospitalGroup PAC ID 9335051093, 20 clinicians

Practice addresses (Care Compare)

1949 W 12 Mile Rd
100 Cor HLTH Univ Hosp
Berkley, MI 48072-1868
Phone (248) 551-0615

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.2 of 100Reported as group
Quality
87.94
Promoting interoperability
100
Improvement activities
40
Cost
63.73

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
William Beaumont Hospital Current Accepting new patients
William Beaumont Hospital CurrentSince Jun 1, 2003 Accepting new patients
William Beaumont Hospital CurrentSince Jun 1, 2003 Accepting new patients
Evergreen Health and Rehabilitation Center, LLC Past Accepting new patients
William Beaumont Hospital Past Accepting new patients
Woodward Hills Health and Rehabilitation Center, LLC Past Accepting new patients
Beaumont Medical Group- Specialty Services Past Accepting new patients

Locations

16815 E Jefferson Ave
Grosse Pointe, MI 48230
Phone (313) 473-4690

3535 W 13 Mile Rd
Ste 108
Royal Oak, MI 48073
Phone (248) 423-3144

3601 W 13 Mile Rd
Royal Oak, MI 48073

130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250

Interoperability endpoints

  • Direct secure messaging: kimam8111@direct.beaumont.edu

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreen Health and Rehabilitation CenterSouthfield, MI, CCN 235582 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2025
Apr 8, 2025
Woodward Hills Health and Rehabilitation Center, LLCBloomfield Hills, MI, CCN 235556 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 7, 2023
Apr 8, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1902865454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR STE 203",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD",
            "address_2": "STE. 108",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736710",
            "telephone_number": "248-551-1756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAM",
        "first_name": "KHALED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301047866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "110F376980",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2947749",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimam8111@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3535 W 13 Mile Rd",
            "address_2": "Ste. 108",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.