Khaleelur R Zackariya Sr., MD

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

01066056A Issued in IN

Practice address

5215 Holycross Parkway
Mishiwaka, IN 46545

Phone

(574) 237-7168

Fax

(574) 472-6262

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
• Indiana University Health Hospital, Indianapolis, IN, CCN 150056
• Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076

Merit-based Incentive Payment System (MIPS)

Final score

82.4 of 100Reported as group

Quality

65.6

Improvement activities

40

Cost

71.06

Merit-based Incentive Payment System (MIPS)

Final score

81.49 of 100Reported as individual

Quality

68.35

Improvement activities

40

Cost

71.8

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kzackariya1155089@direct.trinity-health.org

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.

• Galen Inpatient Physicians, PC

  • Hospitalist Physician
  • Terre Haute, IN
  • NPI 1871178368

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Honor Physicians, LLC

  dba Advanced Internal Medicine of Michiana, LLC

  • Primary Care Clinic/Center
  • Mishawaka, IN
  • NPI 1194288860
  Medicare reassignment NPD
• Northwest Hospitalist Physicians, LLP

  • Emergency Medicine Physician
  • Bloomington, IN
  • NPI 1023448321
  Medicare reassignment NPD
• Sound Physicians of Indiana, LLC

  • Hospitalist Physician
  • Gary, IN
  • NPI 1528311149

  Internal Medicine

  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Indiana, LLC

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1720416555

  IN

  Medicare reassignment
• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Mishawaka, IN
  • NPI 1528885951
  NPD
• Northwest Hospitalist Physicians LLP

  • Hospitalist Physician
  • La Porte, IN
  • NPI 1326415423
  NPD
• Sound Physicians of Indiana, LLC

  dba Sound Physicinas of Indiana

  • Hospitalist Physician
  • Terre Haute, IN
  • NPI 1184063257

  Internal Medicine

  NPD
• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Los Angeles, CA
  • NPI 1205787686
  NPD
• Midwestern Internal Medicine Associates.

  • Internal Medicine Physician
  • Monee, IL
  • NPI 1336474782
  NPD (past)
• Misbah Uddin Ahmed MD SC

  • Internal Medicine Physician
  • Kankakee, IL
  • NPI 1114127800
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Indiana University Health Inc

  dba Indiana University Health

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024
  Care Compare affiliation
• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • General Acute Care Hospital
  • Plymouth, IN
  • NPI 1174571129
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1306854203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 PARK PL",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453520",
            "telephone_number": "574-472-6901",
            "fax_number": "574-472-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLYCROSS PARKWAY",
            "city": "MISHIWAKA",
            "state": "IN",
            "postal_code": "46545",
            "telephone_number": "574-237-7168",
            "fax_number": "574-472-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACKARIYA",
        "first_name": "KHALEELUR",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01066056A",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "IN",
            "license": "01066056A",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036098582",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200930470",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.