NPIMap

Individual provider Active NPI

Mohamed S Kholoki, MD

  • Legal Medicine
  • La Grange Park, IL
National Provider Identifier
1275679755
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
036089463 Issued in IL
Practice address
418 Sherwood Rd
Lagrange Park, IL 60526-1968
Phone
(708) 482-3600
Fax
(708) 482-3005
NPI assigned
Jan 30, 2007
Last updated
Feb 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 036089463 IL Primary

Addresses

Primary practice location

418 Sherwood Rd
Lagrange Park, IL 60526-1968

Mailing address

418 Sherwood Rd
Lagrange Park, IL 60526-1968
Phone (708) 482-3600

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
I20081002000455 IL Practitioner - Internal Medicine 4587732607 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dynamic Physical Therapy, Inc.Group PAC ID 4284607680, 41 clinicians

Practice addresses (Care Compare)

1049 Lake St
Suite 201
Oak Park, IL 60301-6708

418 Sherwood Rd
La Grange Park, IL 60526-1968
Phone (708) 482-3600

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 245-9000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Intermed, LTD Legal Medicine CurrentSince Jul 1, 1990 Accepting new patients
Lagrange Skilled Nursing Facility LLC PastSince Nov 6, 2015 Accepting new patients

Locations

404 Sherwood Rd
La Grange Pk, IL 60526
Phone (708) 428-3600

418 Sherwood Rd
La Grange Pk, IL 60526
Phone (708) 354-1546

5101 Willow Springs Rd
Lagrange Hlds, IL 60525
Phone (708) 245-4073

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ACBACD
  • FHIR API: https://fhir4.healow.com/fhir/r4/ACBACD/Endpoint/ACBACD

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
The Grove of Lagrange Park Living & RehabLa Grange Park, IL, CCN 145307 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 6, 2015
Nov 6, 2015

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 3

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 11

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": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1275679755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 SHERWOOD RD",
            "city": "LAGRANGE PARK",
            "state": "IL",
            "postal_code": "605261968",
            "telephone_number": "708-482-3600",
            "fax_number": "708-482-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 SHERWOOD RD",
            "city": "LAGRANGE PARK",
            "state": "IL",
            "postal_code": "605261968",
            "telephone_number": "708-482-3600",
            "fax_number": "708-482-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOLOKI",
        "first_name": "MOHAMED",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": "036089463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, IL

Sources for this page

Verify at the official NPI Registry.