Wissam E Khoury, DPM
Individual provider
Active NPI
Podiatrist · Cleveland, OH
NPI 1104886910 · NPPES record last updated Mar 22, 2016
Key facts
- NPI
- 1104886910
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 36003289 (OH)
- Practice address
- 2351 E 22ND St
Cleveland, OH 44115
- Phone
- (216) 367-9444
- Fax
- (216) 453-0331
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
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.
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wissam Khoury DPM LLC (13 clinicians)
Practice addresses (Care Compare)
2475 E 22ND St
Suite 120
Cleveland, OH 44115-3221
Phone (216) 367-9444
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 37 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20040826000051 |
OH |
Practitioner - Podiatry |
6002880879 |
Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 36003289 | OH | MD | Podiatrist |
Practice roles
Interoperability endpoints
- Direct secure messaging: wkhoury38089@ehrdirect.uhhospitals.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Podiatrist |
213E00000X |
36003289 |
OH |
Yes |
Addresses
Primary practice location
2351 E 22ND St
Cleveland, OH 44115
Mailing address
429 Front St
Berea, OH 44017-1716
Phone (216) 367-9444
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 2487116 | Medicaid | OH | |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (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.