Individual provider Active NPI

Wasim A Khasawneh, MD

  • Neonatal-Perinatal Medicine Physician
  • Lafayette, IN
National Provider Identifier
1508054446
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
01075923A Issued in IN
Practice address
2600 Greenbush St
Lafayette, IN 47904-2477
Phone
(765) 448-8000
Fax
(765) 488-8564
NPI assigned
Oct 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.098001 OH
Pediatrics Physician 208000000X 01075923A IN
Neonatal-Perinatal Medicine Physician 2080N0001X 01075923A IN Primary
Pediatrics Physician 208000000X 57012659 OH

Addresses

Primary practice location

2600 Greenbush St
Lafayette, IN 47904-2477

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-5510

Other practice location 2

2651 E Discovery Pkwy
Bloomington, IN 47408-9059
Phone (812) 353-9852

Other identifiers 2

IdentifierTypeStateIssuer
000000964894OtherINANTHEM PROVIDER NUMBER
201320950MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wkhasawneh@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20151006000265 IN Practitioner - Pediatric Medicine 7113187790 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.098001OHMDPediatrics Physician
57012659OHMDPediatrics Physician
01075923AINMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Methodist Hospitals, Inc CurrentSince Feb 1, 2023 Accepting new patients
Arnett Clinic, LLC Pediatrics CurrentSince Oct 1, 2015 Accepting new patients
Indiana University Health Southern Indiana Physicians, LLC CurrentSince Dec 5, 2021 Accepting new patients
The Methodist Hospitals, Inc CurrentSince Feb 1, 2023 Accepting new patients
Arnett Clinic, LLC CurrentSince Oct 1, 2015 Accepting new patients
Indiana University Health Southern Indiana Physicians LLC CurrentSince Dec 5, 2021 Accepting new patients
Arnett Clinic, LLC Current Accepting new patients
Iu Health Medical Group Riley Specialists, LLC Pediatrics CurrentSince Jan 1, 2026 Accepting new patients

Locations

8016 Reliable Pkwy
Chicago, IL 60686

27350 Network Pl
Chicago, IL 60673

2651 E Discovery Pkwy
Bloomington, IN 47408
Phone (812) 353-9147

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

2600 Greenbush St
Lafayette, IN 47904

8701 Broadway
Merrillville, IN 46410
Phone (219) 738-4926

200 E 89th Ave
Merrillville, IN 46410
Phone (219) 738-4926

6121 Cleveland St
Merrillville, IN 46410
Phone (219) 738-5985

Interoperability endpoints

  • Direct secure messaging: wkhasawneh@direct.iuhealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508054446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 GREENBUSH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042477",
            "telephone_number": "765-448-8000",
            "fax_number": "765-488-8564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441950001",
            "country_code": "US",
            "telephone_number": "216-444-5510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2651 E Discovery Pkwy",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IN",
            "postal_code": "474089059",
            "country_code": "US",
            "telephone_number": "812-353-9852",
            "fax_number": "812-353-9278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHASAWNEH",
        "first_name": "WASIM",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-04",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.098001",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01075923A",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01075923A",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "57012659",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000964894",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201320950",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wkhasawneh@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2651 E Discovery Pkwy",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474089059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.