NPIMap

Individual provider Active NPI

Fazal Khan, M.D.

  • Family Medicine Physician
  • Huntley, IL
National Provider Identifier
1669430567
Registry record updated Apr 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036104590 Issued in IL
Practice address
10350 Haligus Rd
Huntley, IL 60142-9558
Phone
(815) 338-6600
Fax
(847) 802-7203
NPI assigned
May 2, 2006
Last updated
Apr 24, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036104590 IL Primary

Addresses

Primary practice location

10350 Haligus Rd
Huntley, IL 60142-9558

Mailing address

13707 W Jackson St
Woodstock, IL 60098-3188
Phone (815) 337-1871

Other identifiers 1

IdentifierTypeStateIssuer
080195055OtherILMEDICARE RAILROAD

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
I20100116000161 IL Practitioner - Family Practice 2163564980 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mendota Community HospitalGroup PAC ID 2264335777, 51 clinicians

Practice addresses (Care Compare)

1404 Washington St
Mendota, IL 61342-1471
Phone (815) 539-1825

415 E 2ND St
Spring Valley, IL 61362-1517
Phone (815) 221-1340

790 W Walnut St
Oglesby, IL 61348-1424
Phone (815) 221-1330

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saint James Hospital CurrentSince Jul 2, 2023 Accepting new patients
Mendota Community Hospital CurrentSince Jun 19, 2023 Accepting new patients
Mendota Community Hospital Family Medicine CurrentSince Jun 19, 2023 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Saint James Hospital CurrentSince Jul 2, 2023 Accepting new patients
Osf Multi-Specialty Group CurrentSince Jul 2, 2023 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Mendota Community Hospital Past Accepting new patients

Locations

1404 Washington St
Mendota, IL 61342
Phone (815) 538-1825

1100 E Norris Dr
Ottawa, IL 61350
Phone (815) 416-1224

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1650 Midtown Rd
Peru, IL 61354
Phone (815) 220-1122

415 E 2nd St
Spring Valley, IL 61362
Phone (815) 221-1340

600 E 1st St
Spring Valley, IL 61362
Phone (815) 664-1477

111 Spring St
Fl 4
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 8

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 4

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240531200000",
    "number": "1669430567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13707 W JACKSON ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983188",
            "telephone_number": "815-337-1871",
            "fax_number": "815-338-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10350 HALIGUS RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429558",
            "telephone_number": "815-338-6600",
            "fax_number": "847-802-7203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "FAZAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2009-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036104590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080195055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntley, IL

Sources for this page

Verify at the official NPI Registry.