NPIMap

Individual provider Active NPI

Rakesh Kumar Khosla, M.D.

  • Family Medicine Physician
  • Pueblo, CO
National Provider Identifier
1952466336
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26878 Issued in CO
Practice address
4112 Outlook Blvd Ste 303
Pueblo, CO 81008-1667
Phone
(719) 557-8600
Fax
(719) 557-8615
NPI assigned
Dec 26, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26878 CO Primary
Sports Medicine (Family Medicine) Physician 207QS0010X DR.0026878 CO

Addresses

Primary practice location

4112 Outlook Blvd Ste 303
Pueblo, CO 81008-1667

Mailing address

4112 Outlook Blvd Ste 303
Pueblo, CO 81008-1667
Phone (719) 557-8600

Other practice location 1

1315 Fortino Blvd
Pueblo, CO 81008-1981
Phone (719) 557-8600

Other practice location 2

1315 Fortino Blvd
Pueblo, CO 81008-1981
Phone (719) 557-8600

Other identifiers 2

IdentifierTypeStateIssuer
04131738MedicaidCO
P01078514OtherCOMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20100730000429 CO Practitioner - Family PracticePractitioner - Sports Medicine 1355422783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Baylor College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pueblo Sports and Family Medicine, PLLCGroup PAC ID 5991060253, 2 clinicians

Practice addresses (Care Compare)

1315 Fortino Blvd
Suite C
Pueblo, CO 81008-1981
Phone (719) 544-2740

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26878COMDFamily Medicine Physician
DR.0026878COMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Sports and Family Medicine PLLC Sports Medicine CurrentSince Jul 1, 2018 Accepting new patients
University Family Medicine Center, P.C. Family Medicine PastSince Dec 1, 1995 Accepting new patients

Locations

1315 Fortino Blvd
Ste C
Pueblo, CO 81008
Phone (719) 544-2740

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.

Hospital & facility affiliations 11

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": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1952466336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 OUTLOOK BLVD STE 303",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081667",
            "telephone_number": "719-557-8600",
            "fax_number": "719-557-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 OUTLOOK BLVD STE 303",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081667",
            "telephone_number": "719-557-8600",
            "fax_number": "719-557-8615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1315 Fortino Blvd",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810081981",
            "country_code": "US",
            "telephone_number": "719-557-8600",
            "fax_number": "719-557-8615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 Fortino Blvd",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810081981",
            "country_code": "US",
            "telephone_number": "719-557-8600",
            "fax_number": "719-557-8615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOSLA",
        "first_name": "RAKESH",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "26878",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CO",
            "license": "DR.0026878",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04131738",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01078514",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.