Individual provider Active NPI

Imaad Bin Mujeeb, M. D.

  • Anatomic Pathology & Clinical Pathology Physician
  • McHenry, IL
National Provider Identifier
1689992687
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
036158871 Issued in IL
Practice address
4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone
(815) 759-4806
Fax
(815) 759-4867
NPI assigned
May 14, 2010
Last updated
Nov 30, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 31294 IA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 036158871 IL Primary

Addresses

Primary practice location

4201 W Medical Center Dr
McHenry, IL 60050-8409

Mailing address

4201 W Medical Center Dr
McHenry, IL 60050-8409
Phone (815) 759-4806

Other practice location 1

108 Sunset, Al-Rayyan Road, Al-Messilah
Doha, Doha 00000
QA
Phone (974) 439-2042

Other practice location 2

6420 Clayton Rd
Saint Louis, MO 63117-1811
Phone (314) 768-8202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, 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
I20210716002361 NY Practitioner - PathologyPractitioner - Other (Physician) 1254668742 Reassigns benefits to 3 organizations
I20220113001639 IL Practitioner - Pathology 1254668742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4323

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31294IAMDAnatomic Pathology & Clinical Pathology Physician
036158871ILMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Jan 31, 2022 Accepting new patients
North Shore-Lij Medical PC CurrentSince Apr 9, 2021 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2023 Accepting new patients
Coney Island Medical Practice Plan, P.C. CurrentSince Nov 24, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2023 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Nov 24, 2020 Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4201 W Medical Center Dr
McHenry, IL 60050
Phone (815) 759-3100

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

2300 N Rockton Ave
Rockford, IL 61103

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

8201 E Riverside Blvd
Rockford, IL 61114
Phone (815) 971-4066

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Organizations & group practices 7

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 5

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": "1273795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1689992687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 W MEDICAL CENTER DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508409",
            "telephone_number": "815-759-4806",
            "fax_number": "815-759-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 W MEDICAL CENTER DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508409",
            "telephone_number": "815-759-4806",
            "fax_number": "815-759-4867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 Sunset, Al-Rayyan Road, Al-Messilah",
            "address_purpose": "LOCATION",
            "city": "Doha",
            "state": "Doha",
            "postal_code": "00000",
            "country_code": "QA",
            "telephone_number": "974-439-2042",
            "country_name": "Qatar",
            "address_type": "FGN"
        },
        {
            "address_1": "6420 Clayton Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631171811",
            "country_code": "US",
            "telephone_number": "314-768-8202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUJEEB",
        "first_name": "IMAAD",
        "middle_name": "BIN",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-14",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "31294",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036158871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.