Active NPI
Fawwad Khan
- Psychiatry Physician
- Chicago, IL
National Provider Identifier
1164112744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 125.081546
- Practice address
- 820 S Wood St Ste 100
Chicago, IL 60612-4325 - Phone
- (312) 996-2933
- NPI assigned
- May 9, 2023
- Last updated
- Sep 26, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 125.081546 | IL | Primary |
Addresses
Primary practice location
820 S Wood St Ste 100
Chicago, IL 60612-4325
Mailing address
820 S Wood St Ste 100
Chicago, IL 60612-4325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- University of Texas Southwestern Medical School at Dallas, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8311 Roosevelt Rd
Forest Park, IL 60130-2529
Phone (708) 771-7000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.081546 | IL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riveredge Hospital Inc | Current | Accepting new patients |
Locations
8311 Roosevelt Rd
Forest Park, IL 60130
Phone (708) 488-4968
Interoperability endpoints
- fkhan151023@uihealth.direct-ci.com
Organizations & group practices 1
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.
-
- Psychiatric Hospital
- Forest Park, IL
- NPI 1710070701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1164112744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 S WOOD ST STE 100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606124325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 S WOOD ST STE 100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606124325",
"telephone_number": "312-996-2933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "FAWWAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-09",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "125.081546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.