Bazal Ehsan

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

036156383 Issued in IL

Practice address

221 NE Glen Oak Ave
Peoria, IL 61636-3049

Phone

(309) 339-4357

NPI assigned

Apr 22, 2018

Last updated

Sep 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Internal Medicine

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Methodist Medical Center of IllinoisGroup PAC ID 1355259714, 387 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: behsanmd388410@carlehiedirect.net

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.

• Carle Health Medical Group

  dba Carle Physician Group

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  Medicare reassignment Care Compare group NPD
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment Care Compare group NPD
• Pekin Prohealth Inc

  • Family Medicine Physician
  • Pekin, IL
  • NPI 1932150299
  Medicare reassignment NPD
• Proctor Health Systems

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1134173917
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD
• Methodist Medical Center of Illinois

  dba Methodist Medical Group

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1184670663
  NPD
• Proctor Health Systems

  dba Carle Health Princeville

  • Rural Health Clinic/Center
  • Princeville, IL
  • NPI 1356057301
  NPD

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

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation

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

{
    "created_epoch": "1524355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1497242770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 RIDGE LN APT 4",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605173049",
            "telephone_number": "224-436-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616363049",
            "telephone_number": "309-339-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHSAN",
        "first_name": "BAZAL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-22",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036156383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Egwom, MD
• Prince Osazuwa Ehimamiegho, MD
• Alyssa Joann Ehnle, OTR/L
• Mikell Ryanne Ehnle, PSYD
• Robert R. Ehrich, D.D.S.
• Kathleen Rose Eichinger, M.D.
• Sarah Katherine Eigsti, SLP
• Jamie Eilts, PT
• Ali El Ghazzaoui, MD
• Fahed Nazem Elchami, DPM

• Hospitalist Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Hospitalist Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.