Individual provider Active NPI

Nida Khan, M.D

  • Psychiatry Physician
  • Staten Island, NY
National Provider Identifier
1932447422
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
276218 Issued in NY
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(718) 757-2740
NPI assigned
Jan 18, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 25MA09830800 NJ
Psychiatry Physician 2084P0800X 276218 NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

355 Bard Ave
Staten Island, NY 10310-1664
Phone (718) 757-2740

Other identifiers 1

IdentifierTypeStateIssuer
04030273MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161019001066 NY Practitioner - Psychiatry 8628366952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amboy Medical Practice PCGroup PAC ID 2860538170, 171 clinicians

Practice addresses (Care Compare)

4434 Amboy Rd
Staten Island, NY 10312-3845
Phone (718) 984-9658

669 Castleton Ave
Staten Island, NY 10301-2028
Phone (718) 818-6132

Hospital & facility affiliations

  • Richmond University Medical Center Hospital, Staten Island, NY, CCN 330028

Merit-based Incentive Payment System (MIPS)

Final score
71.48 of 100Reported as apm
Quality
82.91
Promoting interoperability
5.67
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA09830800NJMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC Psychiatry CurrentSince Aug 1, 2016 Accepting new patients
Amboy Medical Practice PC CurrentSince Aug 1, 2016 Accepting new patients

Locations

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1358467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1932447422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-757-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-757-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NIDA",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-18",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA09830800",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "276218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04030273",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.