Individual provider Active NPI

Abubaker Kallan, MD

  • Internal Medicine Physician
  • Springfield, IL
National Provider Identifier
1457090789
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125080566 Issued in IL
Practice address
751 N Rutledge St RM 1100
Springfield, IL 62702-4968
Phone
(217) 545-8000
Fax
(217) 545-4735
NPI assigned
Jun 3, 2022
Last updated
Jun 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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 125080566 IL Primary

Addresses

Primary practice location

751 N Rutledge St RM 1100
Springfield, IL 62702-4968

Mailing address

PO Box 19636
Springfield, IL 62794-9636
Phone (217) 545-4735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20250818000663 IL Practitioner - Internal Medicine 7618358995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

800 E Carpenter St
Springfield, IL 62702-5324
Phone (217) 544-6464

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125080566ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-Illinois Hospitalists, LLP Internal Medicine CurrentSince Aug 28, 2025 Accepting new patients
Cep America-Illinois Hospitalists CurrentSince Aug 28, 2025 Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine Current Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

800 E Carpenter St
Springfield, IL 62702
Phone (217) 525-5643

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 6

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": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1457090789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19636",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949636",
            "telephone_number": "217-545-4735",
            "fax_number": "217-545-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 N RUTLEDGE ST RM 1100",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024968",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAN",
        "first_name": "ABUBAKER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125080566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.