NPIMap

Individual provider Active NPI

M Ghaith Mulki, M.D.

  • Internal Medicine Physician
  • New Lenox, IL
National Provider Identifier
1215953369
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036113818 Issued in IL
Practice address
1890 Silver Cross Blvd Ste 350
New Lenox, IL 60451-9603
Phone
(815) 717-8737
Fax
(815) 717-8699
NPI assigned
Jul 14, 2006
Last updated
Apr 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036113818 IL Primary

Addresses

Primary practice location

1890 Silver Cross Blvd Ste 350
New Lenox, IL 60451-9603

Mailing address

1890 Silver Cross Blvd Ste 350
New Lenox, IL 60451-9603
Phone (815) 717-8737

Other identifiers 1

IdentifierTypeStateIssuer
036113818MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20051019000995 IL Practitioner - Internal Medicine 4880610724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Health Service Systems, IncGroup PAC ID 2264408699, 63 clinicians

Practice addresses (Care Compare)

1890 Silver Cross Blvd
Suite 265
New Lenox, IL 60451-9623
Phone (815) 727-4292

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036113818ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health Service Systems, Inc CurrentSince Apr 1, 2022 Accepting new patients
Health Service Systems, Inc Internal Medicine CurrentSince Apr 1, 2022 Accepting new patients

Locations

1890 Silver Cross Blvd
New Lenox, IL 60451
Phone (815) 300-2802

1890 Silver Cross Blvd
Ste 265
New Lenox, IL 60451
Phone (815) 727-4292

1890 Silver Cross Blvd
Ste 350
New Lenox, IL 60451
Phone (815) 717-8735

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Providence Life ServicesHomer Glen, IL, CCN 146178 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2024
Apr 1, 2024

Owned or controlled facilities with NPI records 1

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

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 5

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429833600000",
    "number": "1215953369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 SILVER CROSS BLVD STE 350",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519603",
            "telephone_number": "815-717-8737",
            "fax_number": "815-717-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 SILVER CROSS BLVD STE 350",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604519603",
            "telephone_number": "815-717-8737",
            "fax_number": "815-717-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULKI",
        "first_name": "M GHAITH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036113818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113818",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Lenox, IL

Sources for this page

Verify at the official NPI Registry.