Individual provider Active NPI

Kashif Shahzad Bhutto, MD

  • Pulmonary Disease Physician
  • Belleville, IL
National Provider Identifier
1083791651
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036105636 Issued in IL
Practice address
4600 Memorial Dr Ste 200
Belleville, IL 62226-5363
Phone
(618) 233-2220
Fax
(618) 233-2555
NPI assigned
Nov 1, 2006
Last updated
Mar 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-4310 AR
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 036105636 IL
Hospitalist Physician 208M00000X 036105636 IL
Pulmonary Disease Physician 207RP1001X 036105636 IL Primary

Addresses

Primary practice location

4600 Memorial Dr Ste 200
Belleville, IL 62226-5363

Mailing address

4600 Memorial Dr
Ste, 120
Belleville, IL 62226-5368
Phone (618) 233-2220

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040831000598 IL Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 3971578204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

4600 Memorial Dr
Suite 200
Belleville, IL 62226-5363
Phone (618) 233-2220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-4310ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Dec 24, 2017 Accepting new patients
Fairview Heights Medical Group SC Current Accepting new patients
Healthcare Physicians of Southern Illinois, PC Internal Medicine Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4600 Memorial Dr
Ste 100
Belleville, IL 62226
Phone (618) 222-0000

4600 Memorial Dr
Ste 120
Belleville, IL 62226
Phone (618) 233-2220

4600 Memorial Dr
Ste 200
Belleville, IL 62226
Phone (618) 233-2220

Interoperability endpoints

  • Direct secure messaging: kbhutto170900@direct.carenet.org

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 4

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1083791651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE, 120",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-233-2220",
            "fax_number": "618-233-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR STE 200",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265363",
            "telephone_number": "618-233-2220",
            "fax_number": "618-233-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHUTTO",
        "first_name": "KASHIF",
        "middle_name": "SHAHZAD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-4310",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IL",
            "license": "036105636",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036105636",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036105636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4600 Memorial Dr Ste 200",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.