NPIMap

Individual provider Active NPI

Faisal Bukhari, MD SC

  • Internal Medicine Physician
  • Sullivan, IL
National Provider Identifier
1376545509
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036088652 Issued in IL
Practice address
2 W Adams St
Sullivan, IL 61951-1943
Phone
(217) 728-7353
Fax
(217) 728-2580
NPI assigned
Jun 1, 2005
Last updated
Apr 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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 036088652 IL Primary

Addresses

Primary practice location

2 W Adams St
Sullivan, IL 61951-1943

Mailing address

2 West Adams
Sullivan, IL 61951-1983
Phone (217) 728-7353

Other identifiers 3

IdentifierTypeStateIssuer
110242003OtherILPALMETTO
036088652MedicaidIL
07021960OtherILBCBS ILLINOIS

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
I20110420000526 IL Practitioner - Internal Medicine 6507041399 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2 W Adams St
Sullivan, IL 61951-1943
Phone (217) 728-7353

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Provider Partners Care Management LP CurrentSince Jan 22, 2025 Accepting new patients
Rural Health Clinic of Moultrie County LLC CurrentSince Nov 3, 2013 Accepting new patients

Locations

4655 W Chase Ave
Lincolnwood, IL 60712
Phone 8472623800202

2 W Adams St
Sullivan, IL 61951
Phone (217) 728-7353

8820 Columbia 100 Pkwy
Ste 430
Columbia, MD 21045
Phone (317) 701-2379

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Sullivan Healthcare & Senior LivingSullivan, IL, CCN 145370 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2024
Dec 1, 2024
Eastview Healthcare & Senior LivingSullivan, IL, CCN 146039 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2024
Dec 1, 2024
Rural Health Clinic of Moultrie County, LLCSullivan, IL, CCN 143847 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 3, 2013

Owned or controlled facilities with NPI records 3

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1376545509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WEST ADAMS",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619511983",
            "telephone_number": "217-728-7353",
            "fax_number": "217-728-2580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 W ADAMS ST",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619511943",
            "telephone_number": "217-728-7353",
            "fax_number": "217-728-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUKHARI",
        "first_name": "FAISAL",
        "credential": "MD SC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036088652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "110242003",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036088652",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ILLINOIS",
            "identifier": "07021960",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, IL

Sources for this page

Verify at the official NPI Registry.