NPIMap

Individual provider Active NPI

Souheil H Khoukaz, MD

  • Interventional Cardiology Physician
  • Festus, MO
National Provider Identifier
1386636868
Registry record updated Oct 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
118388 Issued in MO
Practice address
1390 Highway 61 South
Suite 3300
Festus, MO 63028
Phone
(636) 933-5055
NPI assigned
Aug 19, 2005
Last updated
Oct 26, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 118388 MO
Interventional Cardiology Physician 207RI0011X 118388 MO Primary

Addresses

Primary practice location

1390 Highway 61 South
Suite 3300
Festus, MO 63028

Mailing address

12855 N 40 Dr
Suite 300
Saint Louis, MO 63141-8657
Phone (314) 880-6162

Other identifiers 1

IdentifierTypeStateIssuer
1386636868MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20040604000580 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8820070626 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Heart and Vascular LLCGroup PAC ID 8820016207, 112 clinicians

Practice addresses (Care Compare)

1390 US Hwy 61
Suite N1500
Festus, MO 63028-4137
Phone (314) 251-1700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting13
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
118388MOMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Current Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
SSM Cardiovascular and Thoracic Services, Inc. Cardiovascular Disease Past Accepting new patients
Mercy Support Services Past Accepting new patients
St Louis Cardiology Consultants LTD Cardiovascular Disease Past Accepting new patients
SSM Health Care St. Louis Cardiovascular Disease Past Accepting new patients
Mercy Clinic Cardiovascular and Thoracic Surgery, LLC Past Accepting new patients
Mercy Clinic Adult Critical Care, LLC PastSince Apr 24, 2010 Accepting new patients
Diagnostic Cardiology Services, LTD Cardiovascular Disease Past Accepting new patients
St Louis Cardiology Consultants LTD Cardiovascular Disease Past Accepting new patients
SSM St. Charles Clinic Medical Group, Inc. Past Accepting new patients
St. John's Mercy Support Services Cardiovascular Disease Past Accepting new patients
Critical Care Services, P.C. Past Accepting new patients
Diagnostic Cardiology Services LTD Cardiovascular Disease Past Accepting new patients

Locations

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

Interoperability endpoints

  • Direct secure messaging: skhoukaz99988@directc.mercy.net

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 7

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508976000000",
    "number": "1386636868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR",
            "address_2": "SUITE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418657",
            "telephone_number": "314-880-6162",
            "fax_number": "314-997-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 HIGHWAY 61 SOUTH",
            "address_2": "SUITE 3300",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "63028",
            "telephone_number": "636-933-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOUKAZ",
        "first_name": "SOUHEIL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2017-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "118388",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "118388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386636868",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

Verify at the official NPI Registry.