Roy El Koussa

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036.168094 Issued in IL

Practice address

Mercyhealth Mulford
5970 Churchview Drive
Rockford, IL 61107-2574

Phone

(815) 971-2000

NPI assigned

Mar 23, 2021

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: relkoussa4407664@direct.trinity-health.org

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.

• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1518543065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5124 HOMESTRETCH DR",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MERCYHEALTH MULFORD",
            "address_2": "5970 CHURCHVIEW DRIVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072574",
            "telephone_number": "815-971-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5970 Churchview Dr",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611072574",
            "country_code": "US",
            "telephone_number": "815-971-8990",
            "fax_number": "815-971-9978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EL KOUSSA",
        "first_name": "ROY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-07-03",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.168094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harvey Einhorn
• Alena Kathleen Eitenmiller, DC
• Amy N Ekberg
• Caitlin Rose Ekberg, PT, DPT
• Ekram K. Saeed, DMD, PC
• Ahmed Mohammed Elagez, MD
• Christina Augusta Eldridge, ATC, CSCS
• Elemental ABA
• Elevated Health Essentials, LLC
• Elevated Health LLC Dba Brightstar Care of Rockford

• Internal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.