Mirza Ali U Khan, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.152072 Issued in IL

Practice address

1954 Gateway Center Dr
Belvidere, IL 61008-9303

Phone

(815) 544-7400

NPI assigned

May 24, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, IL2 enrollments

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 2

Specialty

Family Practice

Education

University of Pikeville, Kentucky College of Osteopathic Med, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Healthcare Home Care Home health agency, Loves Park, IL, CCN 147271
• Saint Anthony Medical Center Hospital, Rockford, IL, CCN 140233
• Uw Health Hospital, Rockford, IL, CCN 140228

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527

  IL

  Medicare reassignment Care Compare group NPD
• W. a. Foote Memorial Hospital, Inc

  • Internal Medicine Physician
  • Jackson, MI
  • NPI 1760437826

  MI

  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• W.a. Foote Memorial Hospital, Inc

  • Physician Assistant
  • Jackson, MI
  • NPI 1538606348
  NPD
• Wa Foote Memorial Hospital, Inc

  • Family Medicine Physician
  • Jackson, MI
  • NPI 1215974332

  Family Medicine

  NPD

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

• Saint Anthony Medical Center

  • Home Health Agency
  • Loves Park, IL
  • NPI 1023051992
  Care Compare affiliation
• Saint Anthony Medical Center

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1790739977

  Hospital

  Care Compare affiliation
• Swedishamerican Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1760542732

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1538697248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 ASHWOOD DR",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601238885",
            "telephone_number": "847-528-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1954 GATEWAY CENTER DR",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610089303",
            "telephone_number": "815-544-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MIRZA ALI",
        "middle_name": "U",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-24",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.152072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Kaiser, DPT
• Corinne Michelle Kantor, RN
• Joseph Karpiak, DMD
• Neal Kellenberger, MD
• Kent J Hess MD LLC
• Mohammed Mudasser Khan, MD
• Stephanie Kiesel
• Darla Mae Kieser
• Artis Christin Kisseih, MD
• Lauren M Knodle, SLP

• Family Medicine Physician in Belvidere, IL
• Providers in Belvidere, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.