Anastasia Lvovna Khoubaeva, M.D.

Key facts

NPI

1053643106

Entity type

Individual (NPI type 1)

Primary specialty

Emergency Medicine Physician 207P00000X

License

036129686 (IL)

Practice address

1100 E Norris Dr
Ottawa, IL 61350-1604

Phone

(815) 433-3100

Fax

(815) 433-0879

NPI assigned

Jan 31, 2010

Sex

Female

Sole proprietor

No

Organizations & group practices 10

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.

• Hoopeston Emergency Medicine Specialists, LTD. Emergency Medicine Physician · Hoopeston, IL · NPI 1316965197
  Medicare reassignment Care Compare group NPD EMERGENCY MEDICINE · IL
• Carle Health Care Incorporated Internal Medicine Physician · Urbana, IL · NPI 1154653947
  Medicare reassignment NPD EMERGENCY MEDICINE · IL
• Endeavor Health Medical Group Emergency Medicine Physician · Evanston, IL · NPI 1497701882
  Medicare reassignment NPD EMERGENCY MEDICINE · IL
• Hoopeston Community Memorial Hospital Internal Medicine Physician · Hoopeston, IL · NPI 1043683014
  Medicare reassignment NPD EMERGENCY MEDICINE · IL
• Hoopeston Community Memorial Hospital Critical Access Hospital · Hoopeston, IL · NPI 1366480873
  Medicare reassignment NPD IL
• Osf Multi-Specialty Group Internal Medicine Physician · Peoria, IL · NPI 1922445527
  Medicare reassignment NPD IL
• Valley West Community Hospital Critical Access Hospital · Sandwich, IL · NPI 1184705931
  Medicare reassignment NPD IL
• Endeavor Health Medical Group Anesthesiology Physician · Evanston, IL · NPI 1265695944
  NPD
• Hoopeston Community Memorial Hospital Rural Health Clinic/Center · Hoopeston, IL · NPI 1578504544
  NPD
• Central PA Pharmacy LLC. Community/Retail Pharmacy · Patton, PA · NPI 1578541413
  NPD

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Endeavor Health Clinical Operations General Acute Care Hospital · Evanston, IL · NPI 1184670549
  Care Compare affiliation Hospital
• Hoopeston Community Memorial Hospital Ambulance · Hoopeston, IL · NPI 1164594594
  Care Compare affiliation Hospital
• Hoopeston Community Memorial Hospital Critical Access Hospital · Hoopeston, IL · NPI 1366480873
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Emergency Medicine

Education

Boston University School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hoopeston Emergency Medicine Specialists LTD (12 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northshore University Healthsystem - Evanston Hospital Hospital · Evanston, IL · CCN 140010
• Carle Hoopeston Regional Health Center Hospital · Hoopeston, IL · CCN 141316

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: akhoubaevamd331505@carlehiedirect.net

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 6, 2024.

{
    "created_epoch": "1264896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1053643106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501604",
            "telephone_number": "815-433-3100",
            "fax_number": "815-433-0879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E NORRIS DR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501604",
            "telephone_number": "815-433-3100",
            "fax_number": "815-433-0879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 N Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606114546",
            "country_code": "US",
            "telephone_number": "312-695-6868",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2650 Ridge Ave",
            "address_2": "Evanston Hospital",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "847-570-2114",
            "fax_number": "847-570-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOUBAEVA",
        "first_name": "ANASTASIA",
        "middle_name": "LVOVNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-31",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036129686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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