Individual provider Active NPI

Hadi Mohammad Khan, M.D.

  • Surgery Physician
  • Green Bay, WI
National Provider Identifier
1265605679
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
64318-20 Issued in WI
Practice address
720 S Vanburen St
Suite 201
Green Bay, WI 54301-3534
Phone
(920) 433-7488
Fax
(920) 433-7439
NPI assigned
Apr 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 13520 SD
Surgery Physician 208600000X 64318-20 WI Primary

Addresses

Primary practice location

720 S Vanburen St
Suite 201
Green Bay, WI 54301-3534

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other practice location 1

3015 3rd Ave SE
Aberdeen, SD 57401-5418
Phone (605) 226-5500

Other identifiers 1

IdentifierTypeStateIssuer
64318-20OtherWISTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, NM, SD3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20151027001998 WI Practitioner - Surgical OncologyPractitioner - General Surgery 0840509170 Reassigns benefits to 3 organizations
I20221129000900 NM Practitioner - General SurgeryPractitioner - Surgical Oncology 0840509170 Reassigns benefits to 1 organization
I20230208001279 SD Practitioner - General Surgery 0840509170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health NetworkGroup PAC ID 6800707100, 357 clinicians

Practice addresses (Care Compare)

2905 3Rd Ave SE
Aberdeen, SD 57401-5420
Phone (605) 626-4200

701 3Rd Ave S
Clear Lake, SD 57226-2016
Phone (605) 874-2141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network CurrentSince Apr 24, 2025 Accepting new patients
Agnesian Healthcare Inc Surgery CurrentSince May 1, 2024 Accepting new patients
Sanford Health Network Current Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Jul 29, 2019 Accepting new patients
Dean Health Systems, Inc CurrentSince Jan 24, 2025 Accepting new patients
Sanford Health Network CurrentSince Apr 24, 2025 Accepting new patients
Agnesian Healthcare, Inc Current Accepting new patients
Dean Health Systems, Inc. CurrentSince Jan 24, 2025 Accepting new patients
Agnesian Healthcare Inc CurrentSince May 1, 2024 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Jul 29, 2019 Accepting new patients
Bellin Memorial Hospital Inc Surgery PastSince Aug 24, 2015 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

20 S Plum St
Vermillion, SD 57069
Phone (605) 624-2611

901 4th St NW
Watertown, SD 57201
Phone (605) 882-8780

430 E Division St
Fond du Lac, WI 54935
Phone (920) 926-4200

420 E Division St
Fond du Lac, WI 54935
Phone (920) 923-7400

3400 E Racine St
Janesville, WI 53546
Phone (608) 373-8000

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

360 S Mountin Dr
Mayville, WI 53050
Phone (920) 387-2111

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

620 W Brown St
Waupun, WI 53963
Phone (920) 324-5581

Interoperability endpoints

  • Direct secure messaging: hkhan@yourcarecommunity.org
  • Direct secure messaging: hkhan509862@direct-ehr-ssmhc.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 2

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": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1265605679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S VANBUREN ST",
            "address_2": "SUITE 201",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013534",
            "telephone_number": "920-433-7488",
            "fax_number": "920-433-7439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3015 3rd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Aberdeen",
            "state": "SD",
            "postal_code": "574015418",
            "country_code": "US",
            "telephone_number": "605-226-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "HADI",
        "middle_name": "MOHAMMAD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-07",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SD",
            "license": "13520",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "64318-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "64318-20",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.