Shahbain Internal Medicine LTD
Organization Active NPI Internal Medicine Physician · Palos Heights, IL
NPI 1295924439 · NPPES record last updated Mar 11, 2011
Key facts
- NPI
- 1295924439
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 36085113 (IL)
- Legal business name
- SHAHBAIN INTERNAL MEDICINE LTD
- Practice address
- 12508 S Harlem Ave
Suite C
Palos Heights, IL 60463-1597 - Phone
- (708) 349-0055
- NPI assigned
- Oct 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Abdul Shahbain, M.D.
- Title
- Owner
- Phone
- (708) 349-0055
Practitioners 11
-
Shakir Moiduddin, MD
-
Ivona Barton, NP-C
-
Lisa M De Zoute, APRN, CNP
-
Ghassan Rahhal, MD
-
Mark David Zenke, MSN APRN FNP-C
-
Cesario Monsanto Cumba, M.D.
-
Jennifer Mendaluk, FNP, APN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0998149 | Shahbain Internal Medicine LTD | Certificate of waiver | Apr 7, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040406001567 | IL | Part B Supplier - Clinic/Group Practice | 9537152459 |
Receives reassigned benefits from 7 practitioners Practice locations: Evergreen Park, IL; Tinley Park, IL; Palos Park, IL; Palos Hills, IL; Palos Heights, IL; Orland Park, IL; Oak Lawn, IL; New Lenox, IL… |
National Provider Directory
Locations
219 Bedford Rd
Morris, IL 60450
Phone (815) 942-1633
12508 S Harlem Ave
Palos Heights, IL 60463
Phone (708) 671-1685
12508 S Harlem Ave
Ste C
Palos Heights, IL 60463
Phone (708) 671-1685
18300 Lavergne Ave
Frnt
Tinley Park, IL 60478
Phone (708) 798-2272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 36085113 | IL | Yes |
Addresses
Primary practice location
12508 S Harlem Ave
Suite C
Palos Heights, IL 60463-1597
Mailing address
10660 W 143Rd St
Suite B
Orland Park, IL 60462-1982
Phone (708) 460-4499
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036085113 | Medicaid | IL | |
| 1633951 | Other | IL | BLUE CROSS BLUE SHIELD |
| DA7825 | Other | IL | PALMETTO RR MEDICARE |
Other providers in Palos Heights, IL
- Sentinel Anesthesia of Illinois, PC
- Sumera Seraj
- Christina Marie Serdar
- Niranjan Champaklal Shah
- Nirav A. Shah
- Abdul-Hamid Mohammed Shahbain
- Marco Shaker
- Amy J Shanahan
- Lindsay Shanahan
- Sarah Sheets
All providers in Palos Heights, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.