Individual provider Active NPI

Yehia A. Khoga, MD

  • Child & Adolescent Psychiatry Physician
  • Beloit, WI
National Provider Identifier
1063400810
Registry record updated Mar 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
63732-20 Issued in WI
Practice address
1969 W Hart Rd
Beloit, WI 53511-2230
Phone
(608) 364-5686
Fax
(608) 363-5756
NPI assigned
Oct 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036090712 IL
Child & Adolescent Psychiatry Physician 2084P0804X 63732-20 WI Primary

Addresses

Primary practice location

1969 W Hart Rd
Beloit, WI 53511-2230

Mailing address

1969 W Hart Rd
Beloit, WI 53511-2230
Phone (608) 364-5686

Other identifiers 1

IdentifierTypeStateIssuer
100043967MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150218000863 IL Practitioner - Psychiatry 3072838978 Reassigns benefits to 2 organizations
I20150501001700 WI Practitioner - Psychiatry 3072838978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beloit Health System IncGroup PAC ID 8224947858, 138 clinicians

Practice addresses (Care Compare)

1735 Madison Rd
Beloit, WI 53511-3216
Phone (608) 363-7510

1905 E Huebbe Pkwy
Beloit, WI 53511-1842
Phone (608) 363-5000

1905 W Hart Rd
Beloit, WI 53511-2230
Phone (608) 364-2200

1969 W Hart Rd
Beloit, WI 53511-2230
Phone (608) 364-5756

Hospital & facility affiliations

  • Beloit Health System Hospital, Beloit, WI, CCN 520100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63732-20WIMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Jan 5, 2015 Accepting new patients
Beloit Health System, Inc CurrentSince Apr 6, 2015 Accepting new patients
Beloit Health System Inc Current Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince Jan 5, 2015 Accepting new patients
Beloit Health System, Inc CurrentSince Apr 6, 2015 Accepting new patients
Beloit Clinic, S.C. Current Accepting new patients
Physician Services Corporation of Southern Illinois Inc. CurrentSince Jan 5, 2015 Accepting new patients

Locations

444 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5665

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944

1735 Madison Rd
Beloit, WI 53511
Phone (608) 363-7510

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

Organizations & group practices 7

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": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1063400810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1969 W HART RD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112230",
            "telephone_number": "608-364-5686",
            "fax_number": "608-363-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1969 W HART RD",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112230",
            "telephone_number": "608-364-5686",
            "fax_number": "608-363-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOGA",
        "first_name": "YEHIA",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036090712",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WI",
            "license": "63732-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100043967",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

Verify at the official NPI Registry.