Complete & Comprehensive Kidney Care PLLC

Primary specialty

Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X

Legal business name

COMPLETE & COMPREHENSIVE KIDNEY CARE PLLC

Practice address

810 NW 10TH St Ste a
Oklahoma City, OK 73106-7216

Phone

(405) 272-8367

NPI assigned

Dec 31, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Tariq A Khan, MDNPI 1396804662

Title

Ceo

Phone

(314) 629-8948

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tariq Asadullah Khan, M.D.

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1396804662

  Adolescent Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Shannon L Johnson, CNP, APRN, CNS-RX

  • Family Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1639166499
  Medicare reassignment Care Compare group NPD
• Lauren D'Ann Clark, NP

  • Adult Health Nurse Practitioner
  • Edmond, OK
  • NPI 1821627167
  Medicare reassignment NPD
• Justin Paul Walke, PA-C

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1174193981
  Medicare reassignment

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1922647585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268946",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268946",
            "telephone_number": "405-691-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 NW 10TH ST STE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731067216",
            "telephone_number": "405-272-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE & COMPREHENSIVE KIDNEY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-31",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-629-8948",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "KhanOKC",
            "affiliation": "N",
            "address_1": "810 NW 10th St Ste A",
            "city": "Oklahoma City",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731067216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Adolescent Medicine (Internal Medicine) Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Adolescent Medicine (Internal Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.