Active NPI
Khaled Manasrah, RSA
- Surgical Physician Assistant
- Schaumburg, IL
National Provider Identifier
1114577038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 238.000648
- Practice address
- 904 Jeffery CT
Schaumburg, IL 60193-1332 - Phone
- (224) 288-8847
- NPI assigned
- Sep 12, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 238.000648 | IL | Primary |
| Surgical Assistant | 246ZC0007X | 238.000648 | IL |
Addresses
Primary practice location
904 Jeffery CT
Schaumburg, IL 60193-1332
Mailing address
904 Jeffery CT
Schaumburg, IL 60193-1332
Phone (224) 288-8847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238.000648 | IL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636416000000",
"number": "1114577038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "904 JEFFERY CT",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601931332",
"telephone_number": "224-288-8847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 JEFFERY CT",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601931332",
"telephone_number": "224-288-8847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANASRAH",
"first_name": "KHALED",
"credential": "RSA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-12",
"last_updated": "2021-11-09",
"certification_date": "2021-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "238.000648",
"primary": true
},
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IL",
"license": "238.000648",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schaumburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.