NPIMap

Individual provider Active NPI

Mansoor Khan, MD

  • Internal Medicine Physician
  • Elk Grove Village, IL
National Provider Identifier
1053490920
Registry record updated Apr 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-093169 Issued in IL
Practice address
800 Biesterfield Rd # 407
Elk Grove Village, IL 60007-3311
Phone
(847) 952-7181
Fax
(847) 437-8824
NPI assigned
Nov 3, 2006
Last updated
Apr 8, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-093169 IL Primary

Addresses

Primary practice location

800 Biesterfield Rd # 407
Elk Grove Village, IL 60007-3311

Mailing address

PO Box 7077
Villa Park, IL 60181-7077
Phone (847) 952-7181

Other identifiers 2

IdentifierTypeStateIssuer
110189123OtherILRAILROAD MEDICARE
364302965OtherILTAX IDENTIFICATION NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080226000548 IL Practitioner - Internal Medicine 2769566009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

800 Biesterfield Rd
Suite 407
Elk Grove Village, IL 60007-3378
Phone (847) 264-8618

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.59 of 100Reported as group
Quality
81.19
Improvement activities
40
Cost
80.39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-093169ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mansoor Khan MD SC Internal Medicine CurrentSince Aug 1, 1999 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

800 Biesterfield Rd
Ste 407
Elk Grove Vlg, IL 60007
Phone (815) 588-3866

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FJHCBD/Endpoint/FJHCBD

Organizations & group practices 3

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 9

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239148800000",
    "number": "1053490920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7077",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601817077",
            "telephone_number": "847-952-7181",
            "fax_number": "847-437-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BIESTERFIELD RD # 407",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073311",
            "telephone_number": "847-952-7181",
            "fax_number": "847-437-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MANSOOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2009-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-093169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110189123",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "364302965",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove Village, IL

Sources for this page

Verify at the official NPI Registry.