Individual provider Active NPI

Hatem Khatab

  • Physical Therapist
  • Oak Lawn, IL
National Provider Identifier
1083766794
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
9614 S. Merton Ave.
Oak Lawn, IL 60453
Phone
(708) 296-9771
Fax
(708) 422-4436
NPI assigned
Jan 16, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

9614 S. Merton Ave.
Oak Lawn, IL 60453

Mailing address

9614 S. Merton Ave.
Oak Lawn, IL 60453
Phone (708) 296-9771

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040917001161 IL Practitioner - Physical Therapist in Private Practice 6305814369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9848 Southwest Hwy
Oak Lawn, IL 60453-3662
Phone (708) 296-9771

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Rehabilitation Services P.C. Physical Therapist CurrentSince May 4, 2004 Accepting new patients
In Touch Home Health Agency Inc PastSince Jul 27, 2010 Accepting new patients
Optimal Potential, Inc. Physical Therapist Past Accepting new patients
Ashunti Residential Management Systems Past Accepting new patients
Chicago Reach Foundation Past Accepting new patients

Locations

4350 W 16th St
Chicago, IL 60623
Phone (773) 277-1200

9848 Southwest Hwy
Oak Lawn, IL 60453
Phone (708) 296-9771

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083766794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9614 S. MERTON AVE.",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "60453",
            "telephone_number": "708-296-9771",
            "fax_number": "708-422-4436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9614 S. MERTON AVE.",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "60453",
            "telephone_number": "708-296-9771",
            "fax_number": "708-422-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHATAB",
        "first_name": "HATEM",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.