NPIMap

Individual provider Active NPI

Mark James Khoury, DO

  • Emergency Medicine Physician
  • Monroe, MI
National Provider Identifier
1134612765
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5151011858 Issued in MI
Practice address
718 N Macomb St
Monroe, MI 48162-7815
Phone
(734) 240-8400
NPI assigned
Jun 8, 2018
Last updated
Sep 19, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X 5151011858 MI Primary

Addresses

Primary practice location

718 N Macomb St
Monroe, MI 48162-7815

Mailing address

17434 Leafdale CT
Macomb, MI 48044-5565
Phone (586) 344-8962

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210728002050 FL Practitioner - Emergency Medicine 9032512009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Services of FL LLCGroup PAC ID 8426413931, 686 clinicians
Florida Emergency Physicians Kang and Associates MD LLCGroup PAC ID 0143113878, 318 clinicians

Practice addresses (Care Compare)

119 Oakfield Dr
Brandon, FL 33511-5779
Phone (813) 681-5551

1909 E Hwy 50
Clermont, FL 34711-1921
Phone (352) 717-3800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5151011858MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of FL, LLC Emergency Medicine CurrentSince Sep 2, 2024 Accepting new patients
Florida Emergency Physicians Kang and Associates MD LLC Emergency Medicine CurrentSince Aug 1, 2021 Accepting new patients

Locations

119 Oakfield Dr
Brandon, FL 33511
Phone (813) 571-5150

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

1909 E Highway 50
Clermont, FL 34711
Phone (352) 717-3800

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

105 Tamiami Trl
Fl Tamiami
Port Charlotte, FL 33953

14000 Fivay Rd
Port Richey, FL 34667
Phone (727) 819-2929

1000 Waterman Way
Tavares, FL 32778
Phone (352) 253-3333

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 2

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 6

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": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1134612765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17434 LEAFDALE CT",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445565",
            "telephone_number": "586-344-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481627815",
            "telephone_number": "734-240-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOURY",
        "first_name": "MARK",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-08",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5151011858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.