Individual provider Active NPI

Maqsood Ahmed Khan, M.D

  • Gastroenterology Physician
  • West Allis, WI
National Provider Identifier
1811019680
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
62273 Issued in WI
Practice address
2424 S 90TH St
Suite 306
West Allis, WI 53227-2455
Phone
(414) 328-8750
NPI assigned
Apr 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X AW3893559 IL
Gastroenterology Physician 207RG0100X 62273 WI Primary

Addresses

Primary practice location

2424 S 90TH St
Suite 306
West Allis, WI 53227-2455

Mailing address

PO Box 735044
Chicago, IL 60673-5044

Other identifiers 1

IdentifierTypeStateIssuer
100038844MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mkhan118096@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20140617000574 WI Practitioner - GastroenterologyPractitioner - Internal Medicine 2769534528 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians
Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

1020 N 12TH St
Milwaukee, WI 53233-1308
Phone (414) 219-3056

1032 E Sumner St
Hartford, WI 53027-1608
Phone (262) 673-2300

1055 N Mayfair Rd
Wauwatosa, WI 53226-3436
Phone (414) 476-8450

2000 E Layton Ave
Saint Francis, WI 53235-6053
Phone (414) 744-6589

2424 S 90TH St
West Allis, WI 53227-2455
Phone (414) 328-8630

3003 W Good Hope Rd
Milwaukee, WI 53209-2042
Phone (414) 352-3100

4448 W Loomis Rd
Greenfield, WI 53220-4800
Phone (414) 281-5150

8901 W Lincoln Ave
West Allis, WI 53227-2409
Phone (414) 329-5930

975 Port Washington Rd
Grafton, WI 53024-9204
Phone (262) 329-8650

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy168
Upper gastrointestinal (GI) endoscopy for acid reflux202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
AW3893559ILMDInternal Medicine Physician
62273WIMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Internal Medicine Current Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Aug 1, 2014 Accepting new patients
Aurora Advanced Healthcare, Inc. Internal Medicine CurrentSince Aug 1, 2014 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 1, 2015 Accepting new patients
Lakeshore Medical Clinic, LLC CurrentSince Aug 1, 2014 Accepting new patients
Lakeshore Medical Clinic LTD CurrentSince Aug 1, 2014 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Feb 1, 2015 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

4448 W Loomis Rd
Milwaukee, WI 53220
Phone (414) 281-5150

9000 W Sura Ln
Milwaukee, WI 53228
Phone (414) 246-6500

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

2000 E Layton Ave
St Francis, WI 53235
Phone (414) 744-7880

2424 S 90th St
Ste 306
West Allis, WI 53227
Phone (414) 328-8720

2424 S 90th St
West Allis, WI 53227
Phone (414) 321-2255

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 and National Provider Directory roles.

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": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1811019680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "address_2": "SUITE 306",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-328-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MAQSOOD",
        "middle_name": "AHMED",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "AW3893559",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WI",
            "license": "62273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100038844",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkhan118096@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2424 S 90th St",
            "address_2": "Suite 306",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2424 S 90th St",
            "address_2": "Suite 306",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.