Nizar Kherallah, MD

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

35072648 Issued in OH

Practice address

530 NE Glen Oak Ave Dept of
Peoria, IL 61637-2673

Phone

(309) 624-9844

Fax

(309) 624-9844

NPI assigned

Sep 15, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nizar.kherallah.1@7598.direct.athenahealth.com

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.

• St Vincent Pediatric Subspecialties

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1013967736

  Pediatric Pulmonology

  Medicare reassignment NPD
• St Vincent Pediatric Subspecialties

  • Pediatric Critical Care Medicine Physician
  • Evansville, IN
  • NPI 1851950224

  Pediatric Pulmonology

  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)
• St. Vincent Medical Group, Inc.

  • Internal Medicine Physician
  • Carmel, IN
  • NPI 1811881527
  NPD (past)

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1669467726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE DEPT OF",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616372673",
            "telephone_number": "309-624-9844",
            "fax_number": "309-624-9844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 Cherry St",
            "address_2": "Suite 2900",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436082673",
            "country_code": "US",
            "telephone_number": "419-251-6430",
            "fax_number": "419-251-6433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHERALLAH",
        "first_name": "NIZAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "OH",
            "license": "35072648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2122661",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabina Khan, M.D.
• Shahabal Khan
• Taariq Ahsan Khan, MD
• Muhammad Waqar Khattak, M.D.
• Bassil Kherallah, MD
• Akash Khetpal
• Khoury Chiropractic Inc
• Sarah M Khoury, DPT
• Tracie A Khoury, DC
• Kidney Care Center Bloomington LLC

• Pediatric Pulmonology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Pediatric Pulmonology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.