NPIMap

Individual provider Active NPI

Kaleem Khan, M.D.

  • Family Medicine Physician
  • Naperville, IL
National Provider Identifier
1619917713
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036098700 Issued in IL
Practice address
1331 W 75TH St Ste 202
Naperville, IL 60540-9311
Phone
(630) 922-1400
NPI assigned
Jun 7, 2006
Last updated
Sep 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036098700 IL
Family Medicine Physician 207Q00000X 036098700 IL Primary

Addresses

Primary practice location

1331 W 75TH St Ste 202
Naperville, IL 60540-9311

Mailing address

1331 W 75TH St
Naperville, IL 60540-9336
Phone (630) 922-1400

Other practice location 1

640 W Washington St
Pittsfield, IL 62363-1350
Phone (217) 285-2113

Other identifiers 1

IdentifierTypeStateIssuer
036098700MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkhan38115@direct.edward.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050506000527 IL Practitioner - Family Practice 5496795601 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

1331 W 75TH St
Naperville, IL 60540-9311

2650 Ridge Ave
Evanston, IL 60201-1700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036098700ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Health Ventures CurrentSince Mar 1, 2014 Accepting new patients
Endeavor Health Medical Group CurrentSince Dec 19, 2023 Accepting new patients
Endeavor Health Medical Group Emergency Medicine Current Accepting new patients
Edward Health Ventures CurrentSince Mar 1, 2014 Accepting new patients

Locations

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
#1223
Evanston, IL 60201
Phone (847) 982-3172

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

3033 Ogden Ave
Ste 101
Lisle, IL 60532
Phone (630) 646-6200

120 Spalding Dr
Ste 101
Naperville, IL 60540
Phone (630) 527-7730

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

1331 W 75th St
Ste 202
Naperville, IL 60540
Phone (630) 305-3025

2007 95th St
Ste 105
Naperville, IL 60564
Phone (630) 646-6920

2132 Deep Water Ln
Ste 228
Naperville, IL 60564
Phone (630) 922-1400

6701 US Highway 34
Oswego, IL 60543
Phone (630) 646-4200

Interoperability endpoints

  • Direct secure messaging: kkhan38115@direct.edward.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Patrick's ResidenceNaperville, IL, CCN 145878 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2023
Mar 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • St Patrick Residence

    dba St. Patrick's Residence

    • Skilled Nursing Facility
    • Naperville, IL
    • NPI 1811982507

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1619917713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 W 75TH ST",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605409336",
            "telephone_number": "630-922-1400",
            "fax_number": "630-904-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 W 75TH ST STE 202",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605409311",
            "telephone_number": "630-922-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 W Washington St",
            "address_purpose": "LOCATION",
            "city": "Pittsfield",
            "state": "IL",
            "postal_code": "623631350",
            "country_code": "US",
            "telephone_number": "217-285-2113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "KALEEM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036098700",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036098700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098700",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkhan38115@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "1331 W 75th St Ste 202",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605409311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.