Individual provider Active NPI

Mahrukh Khan, M.D.

  • Adult Medicine Physician
  • St. Louis, MO
National Provider Identifier
1568596336
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
112340 Issued in MO
Practice address
7491 Big Bend Blvd.
St. Louis, MO 63119
Phone
(314) 961-3038
Fax
(314) 961-6731
NPI assigned
Mar 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 112340 MO Primary

Addresses

Primary practice location

7491 Big Bend Blvd.
St. Louis, MO 63119

Mailing address

PO Box 2153 Dept #30704
Birmingham, AL 35287-9257
Phone (314) 961-3038

Other practice location 1

14 Park Pl Ste A
Swansea, IL 62226-2929
Phone (618) 398-6266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, 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

Enrollment IDStateProvider typePAC IDDetails
I20040413000813 MO Practitioner - Family Practice 8325032261 Reassigns benefits to 1 organization
I20110214000756 IL Practitioner - Family Practice 8325032261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2345 Dougherty Ferry Rd
Saint Louis, MO 63122-3313
Phone (314) 966-9100

7491 Big Bend Blvd
Saint Louis, MO 63119-2101

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Saint Louis, MO, CCN 267565
  • Mercy Hospital South Hospital, Saint Louis, MO, CCN 260077
  • Mercy Hospital St Louis Hospital, Saint Louis, MO, CCN 260020
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Merit-based Incentive Payment System (MIPS)

Final score
89.75 of 100Reported as individual
Quality
73
Improvement activities
40
Cost
85.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
112340MOMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Healthcare LTD Adult Medicine CurrentSince Sep 15, 2000 Accepting new patients
County of St Louis Division of Fiscal Management Past Accepting new patients

Locations

180 S 3rd St
Belleville, IL 62220
Phone (618) 233-5480

746 Urbanna Dr
Freeburg, IL 62243
Phone (618) 317-1537

14 Park Pl
Ste A
Swansea, IL 62226
Phone (618) 277-3332

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

300 Liguori Dr
Barnhart, MO 63012

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

2345 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 821-5850

7491 Big Bend Blvd
Webster Groves, MO 63119
Phone (314) 961-3038

140 E Lockwood Ave
Webster Groves, MO 63119
Phone (314) 961-3038

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1568596336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT #30704",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352879257",
            "telephone_number": "314-961-3038",
            "fax_number": "314-961-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7491 BIG BEND BLVD.",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63119",
            "telephone_number": "314-961-3038",
            "fax_number": "314-961-6731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Park Pl Ste A",
            "address_purpose": "LOCATION",
            "city": "Swansea",
            "state": "IL",
            "postal_code": "622262929",
            "country_code": "US",
            "telephone_number": "618-398-6266",
            "fax_number": "618-398-6293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MAHRUKH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "112340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Louis, MO

Sources for this page

Verify at the official NPI Registry.