Jalal Dahshe, MD
Individual provider Active NPI Internal Medicine Physician · Burbank, IL
NPI 1790716967 · NPPES record last updated Apr 12, 2017
Key facts
- NPI
- 1790716967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036088926 (IL)
- Practice address
- 4817 W 83Rd St
Burbank, IL 60459-2790 - Phone
- (708) 425-3135
- Fax
- (708) 425-6884
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4817 W 83Rd St
Burbank, IL 60459-2790
Phone (708) 425-3135
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031223000335 | IL | Practitioner - Internal Medicine | 6204734650 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Foot Ankle, LLC | Current |
Accepting new patients | |
| Burbank Medical Group Inc | Internal Medicine | Current |
Accepting new patients |
| Professional Health Sport, Inc. | Past | Accepting new patients | |
| Burbank Medical Center SC | Internal Medicine | Past |
Accepting new patients |
| San Pablo Medical Center, LTD. | Internal Medicine | Past | Accepting new patients |
Locations
4817 W 83rd St
Burbank, IL 60459
Phone (708) 425-3135
6253 W 95th St
Ste 1A
Oak Lawn, IL 60453
Phone (630) 401-8286
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036088926 | IL | Yes |
Addresses
Primary practice location
4817 W 83Rd St
Burbank, IL 60459-2790
Mailing address
12082 Blackthorne Ridge Dr
Mokena, IL 60448-8118
Phone (773) 459-8227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036088926 | Medicaid | IL | |
| 01608243 | Other | IL | BLUE CROSS |
| 01639156 | Other | IL | BLUE CROSS |
Other providers in Burbank, IL
- Dorcy Celia Covarrubias
- Charles Joseph Cranny
- Chelsea Kay Crumbleholme
- Susan Victoria Cullen
- Eric Michael Czajkowski
- Francis De Castro
- Sara Christine De Van
- Lynn Ann Dedecker
- Lea Dela Pena
- Humberto Deleon
All providers in Burbank, IL · Internal Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.