Individual provider Active NPI

Shubh Khullar

  • Certified Registered Nurse Anesthetist
  • Portland, OR
National Provider Identifier
1972331411
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
10024236 Issued in OR
Practice address
4805 NE Glisan St
Portland, OR 97213-2933
Phone
(786) 852-5196
NPI assigned
Jul 25, 2024
Last updated
Jul 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 10024236 OR Primary
Certified Registered Nurse Anesthetist 367500000X 149014 FL

Addresses

Primary practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

14222 SW 101St LN
Miami, FL 33186-6967
Phone (786) 852-5196

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250109002004 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 5395273940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of Washington - TCSGroup PAC ID 6800240102, 197 clinicians

Practice addresses (Care Compare)

4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 215-1111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149014FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Washington - TCS Nurse Anesthetist, Certified Registered CurrentSince Nov 8, 2024 Accepting new patients

Locations

4805 NE Glisan St
Portland, OR 97213
Phone (503) 215-1111

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Organizations & group practices 1

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 2

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": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1972331411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14222 SW 101ST LN",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866967",
            "telephone_number": "786-852-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132933",
            "telephone_number": "786-852-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHULLAR",
        "first_name": "SHUBH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "10024236",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "149014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.