Shagufta Naaz Khader, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036141712 Issued in IL

Practice address

630 E North Ave
Dept of Family Medicine
Carol Stream, IL 60188

Phone

(630) 458-5300

NPI assigned

Jun 5, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Family Practice

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Inner-City Muslim Action NetworkGroup PAC ID 4183942212, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shagufta.khader.2@380.direct.athenahealth.com
• Direct secure messaging: shagufta.khader.1@12349.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.

• Inner-City Muslim Action Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1003244567

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Inner-City Muslim Action Network

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1073106621
  NPD

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1851704043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E NORTH AVE",
            "address_2": "DEPT OF FAMILY MEDICINE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "60188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E NORTH AVE",
            "address_2": "DEPT OF FAMILY MEDICINE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "60188",
            "telephone_number": "630-458-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "327 Gundersen Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Carol Stream",
            "state": "IL",
            "postal_code": "601882453",
            "country_code": "US",
            "telephone_number": "630-462-7957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHADER",
        "first_name": "SHAGUFTA",
        "middle_name": "NAAZ",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-05",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036141712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shagufta.khader.2@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "630 E North Ave",
            "address_2": "Dept of Family Medicine",
            "city": "Carol Stream",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mirha Karic, FNP
• Peter J Katris, D.D.S.
• Ripa V Katwala, PHARM D
• KB Bilingual Therapy LLC
• Christa Kentfield, OTR/L
• Sohail Khan, PHARMD
• Amy Johnson Kim, D.D.S.
• James H Kim, MD
• Joy Kim, MD
• Danielle M Kirby, PT, DPT

• Family Medicine Physician in Carol Stream, IL
• Providers in Carol Stream, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.