Nasiruddin Khokhar, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036-058827 Issued in IL

Practice address

1404 Eastland Dr Ste 103
Bloomington, IL 61701-7904

Phone

(309) 434-3151

NPI assigned

Apr 24, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mycare Express Care Inc

  • Specialist
  • Bloomington, IL
  • NPI 1396464657
  Medicare reassignment NPD

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

{
    "created_epoch": "1650758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1093459299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 WOODBINE RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 EASTLAND DR STE 103",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017904",
            "telephone_number": "309-434-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOKHAR",
        "first_name": "NASIRUDDIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-24",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-058827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D13978",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claire Therese Keogh
• Alison Nicole Kerrn
• Hannah Keun
• Kevin K Schultz, DDS, PC
• Yasir Khan
• Omar S Khokhar, MD
• Cathy Kiel, RPH
• David L Kieser, APN, FNP
• Erika Kietzman, LAT, ATC
• Kim Baldwin Psychological Services, PLLC

• Internal Medicine Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.