Adel Khdour, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

81805 Issued in WI

Practice address

5333 Douglas Ave
Racine, WI 53402-2032

Phone

(262) 752-2100

Fax

(262) 752-2122

NPI assigned

Aug 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN, 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

Specialty

Family Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
• Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: khdoura@direct.iuhealth.org
• Direct secure messaging: akhdour384653@direct.myadvocateaurora.org

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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Arnett Clinic, LLC

  • Internal Medicine Physician
  • Lafayette, IN
  • NPI 1164490843

  Family Medicine

  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• Arnett Clinic, LLC

  • Durable Medical Equipment & Medical Supplies
  • Lafayette, IN
  • NPI 1699839563
  NPD
• Arnett Clinic, LLC

  • Clinical Medical Laboratory
  • Lafayette, IN
  • NPI 1881655090
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)

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

• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Kenosha, WI
  • NPI 1225156888
  Care Compare affiliation
• Visiting Nurse Association of Wisconsin, Inc.

  • Home Health Agency
  • West Allis, WI
  • NPI 1134255037
  Care Compare affiliation

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1083806384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 DOUGLAS AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534022032",
            "telephone_number": "262-752-2100",
            "fax_number": "262-752-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "810 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "IN",
            "postal_code": "479608201",
            "country_code": "US",
            "telephone_number": "765-448-8000",
            "fax_number": "574-583-9502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHDOUR",
        "first_name": "ADEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-10",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "81805",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036118811",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01064330A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251357",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000531548",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN - URGENT CARE UNDER TIN 35-2030653",
            "identifier": "000001014115",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200876650",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khdoura@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "810 S 6th St",
            "city": "Monticello",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479608201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karl Thomas Keller, DC
• Wendy Carroll Kelly
• Richard John Kemper, DDS
• Mark R Kenfield, DDS
• Kenosha Community Health Center, Inc.
• Abigail Kibler
• Cynthia Ann Kickland
• Janet E. Kieslich, N.P.
• Daniel Yeil Kim, D.M.D.
• Robert B.H. Kim, MD MBA

• Family Medicine Physician in Racine, WI
• Providers in Racine, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.