Individual provider Active NPI

Khalid Al-Khafaji, M.D.

  • Cardiovascular Disease Physician
  • Maywood, IL
National Provider Identifier
1588070031
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036142953 Issued in IL
Practice address
2160 S 1St Ave
Maywood, IL 60153-3328
Phone
(708) 216-9000
NPI assigned
Jul 5, 2014
Last updated
May 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.065337 IL
Cardiovascular Disease Physician 207RC0000X 01085781A IN
Cardiovascular Disease Physician 207RC0000X 036142953 IL Primary
Hospitalist Physician 208M00000X 036.142953 IL

Addresses

Primary practice location

2160 S 1St Ave
Maywood, IL 60153-3328

Mailing address

624 Sheridan Rd
Apt# 3a
Highwood, IL 60040-1055
Phone (832) 450-1101

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kalkhafaji145402@direct.luhs.org Direct LOYOLA UNIVERSITY MEDICAL CENTER

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
I20230113001901 IN Practitioner - Cardiovascular Disease (Cardiology) 0042566564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Porte Clinic Company LLCGroup PAC ID 0446558357, 66 clinicians

Practice addresses (Care Compare)

102 E Culver Rd
Knox, IN 46534-2216
Phone (574) 772-6231

104 E Culver Rd
Knox, IN 46534-2241

1331 State St
La Porte, IN 46350-3112

1509 State St
La Porte, IN 46350-3115
Phone (219) 326-5700

3777 N Frontage Rd
Suite 700
Michigan City, IN 46360-7698
Phone (219) 878-3217

85 E US Hwy 6
Valparaiso, IN 46383-8947
Phone (219) 878-3217

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.68 of 100Reported as apm
Quality
76.2
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.065337ILMDInternal Medicine Physician
01085781AINMDCardiovascular Disease Physician
036.142953ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Porte Clinic Company LLC CurrentSince Feb 1, 2023 Accepting new patients
Loyola University Medical Center Current Accepting new patients
La Porte Clinic Company LLC Internal Medicine CurrentSince Feb 1, 2023 Accepting new patients
Porter Physician Services LLC Internal Medicine Past Accepting new patients

Locations

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580

104 E Culver Rd
Ste 102
Knox, IN 46534
Phone (574) 772-1580

104 E Culver Rd
Ste 105
Knox, IN 46534
Phone (574) 772-7300

1331 State St
Ste 140
La Porte, IN 46350
Phone (219) 324-0014

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

3777 N Frontage Rd
Ste 300
Michigan City, IN 46360
Phone (219) 379-3166

6923 W 400 N
Michigan City, IN 46360
Phone (219) 325-0604

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1404518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1588070031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 SHERIDAN RD",
            "address_2": "APT# 3A",
            "city": "HIGHWOOD",
            "state": "IL",
            "postal_code": "600401055",
            "telephone_number": "832-450-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL-KHAFAJI",
        "first_name": "KHALID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-05",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.065337",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01085781A",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036142953",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036.142953",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kalkhafaji145402@direct.luhs.org",
            "affiliation": "Y",
            "endpointDescription": "kalkhafaji145402@direct.luhs.org",
            "affiliationName": "LOYOLA UNIVERSITY MEDICAL CENTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S 1st Ave",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601533328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.