Khaled Issa

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

35058319 Issued in OH

Practice address

30701 Clemens Rd
Westlake, OH 44145-1074

Phone

(440) 617-1212

Fax

(440) 617-1213

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

GastroenterologyAlso: Internal Medicine

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cleveland Clinic Hospital, Cleveland, OH, CCN 360180
• Fairview Hospital Hospital, Cleveland, OH, CCN 360077
• Cleveland Clinic Avon Hospital Hospital, Avon, OH, CCN 360364
• Medina Hospital Hospital, Medina, OH, CCN 360091

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment Care Compare group NPD
• Govind K Mehta, M.D., Inc.

  • Otolaryngology Physician
  • Elyria, OH
  • NPI 1215200811
  NPD (past)
• North Shore Endoscopy Center

  • Gastroenterology Physician
  • Westlake, OH
  • NPI 1467474585
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Cleveland Clinic Avon Hospital

  • General Acute Care Hospital
  • Avon, OH
  • NPI 1346607017
  Care Compare affiliation
• Fairview Hospital

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1215989611
  Care Compare affiliation
• Medina Hospital

  • General Acute Care Hospital
  • Medina, OH
  • NPI 1083696710
  Care Compare affiliation
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Care Compare affiliation

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1801818646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30701 CLEMENS ROAD",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "44145",
            "telephone_number": "440-617-1212",
            "fax_number": "440-617-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30701 CLEMENS RD",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451074",
            "telephone_number": "440-617-1212",
            "fax_number": "440-617-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISSA",
        "first_name": "KHALED",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35058319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0844439",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100014941",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jackosky Health Inc
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• Gastroenterology Physician in Westlake, OH
• Providers in Westlake, OH by specialty
• Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.