Mahamid Ali Khan, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019024670 Issued in IL

Practice address

6447 Cermak Rd
Berwyn, IL 60402-2311

Phone

(773) 254-1400

Fax

(312) 829-6375

NPI assigned

Aug 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Alivio Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Berwyn, IL
  • NPI 1255646857

  Corporate Officer

  CMS ownership
• Alivio Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1073617387

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Alivio Medical Center, Inc.

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1083860845

  W-2 Managing Employee

  CMS ownership
• Alivio Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1710096482

  W-2 Managing Employee

  CMS ownership

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.

• Alivio Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1073617387
  Medicare reassignment NPD
• Alivio Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Berwyn, IL
  • NPI 1255646857
  NPD
• Alivio Medical Center, Inc.

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1083860845
  NPD

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1164424016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 W 21ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606084511",
            "telephone_number": "773-254-1400",
            "fax_number": "312-829-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6447 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022311",
            "telephone_number": "773-254-1400",
            "fax_number": "312-829-6375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5701 Delmar Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631122617",
            "country_code": "US",
            "telephone_number": "314-367-7848",
            "fax_number": "314-367-2985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MAHAMID",
        "middle_name": "ALI",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2005002250",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019024670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019024670",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407262500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canaan Kerr, MD MS
• Alicia Kevelin
• Corita Key
• Khalaf H Khalifeh, D.C
• Basmah Khalil, M.D.
• Muhammad Taimur Khan, BDS, MPH, MS
• Sameer Khan, DPM
• Syed J Khan, MD
• Sharad K Khandelwal, MD
• Adam W Kielbasa, PHARMD.

• Dentist in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.