NPIMap

Individual provider Active NPI

Murtuza H Bahrainwala, MD

  • Internal Medicine Physician
  • Forsyth, IL
National Provider Identifier
1871590679
Registry record updated Feb 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11055 Issued in NV
Practice address
509 Lucas LN
Forsyth, IL 62535-8978
Phone
(217) 791-5071
NPI assigned
Jul 7, 2005
Last updated
Feb 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11055 NV Primary

Addresses

Primary practice location

509 Lucas LN
Forsyth, IL 62535-8978

Mailing address

509 Lucas LN
Forsyth, IL 62535-8978
Phone (217) 791-5071

Other identifiers 1

IdentifierTypeStateIssuer
100503973MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070613000043 IL Practitioner - Internal Medicine 8628032695 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1995
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Ahs Il Medical Group LLCGroup PAC ID 5496111676, 46 clinicians

Practice addresses (Care Compare)

2044 Madison Ave
Granite City, IL 62040-4641
Phone (618) 451-1500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
52.59 of 100Reported as individual
Quality
78.44
Promoting interoperability
0
Improvement activities
40
Cost
46.87

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11055NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Apr 22, 2013 Accepting new patients
Ahs Il Medical Group LLC CurrentSince Oct 8, 2023 Accepting new patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Apr 22, 2013 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

101 United Dr
Collinsville, IL 62234
Phone (618) 344-0248

2044 Madison Ave
Ste 15
Granite City, IL 62040
Phone (618) 451-1500

2100 Madison Ave
Ste 301
Granite City, IL 62040

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

650 W Taylor St
Vandalia, IL 62471
Phone (618) 283-1231

825 New York Dr
Vandalia, IL 62471
Phone (217) 258-2409

Interoperability endpoints

  • Direct secure messaging: mbahrain@yourcarecommunity.org
  • Direct secure messaging: murtuza.bahrainwala.1@28328.direct.athenahealth.com

Organizations & group practices 4

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 10

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1871590679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 LUCAS LN",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625358978",
            "telephone_number": "217-791-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 LUCAS LN",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "625358978",
            "telephone_number": "217-791-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHRAINWALA",
        "first_name": "MURTUZA",
        "middle_name": "H",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "11055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503973",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forsyth, IL

Sources for this page

Verify at the official NPI Registry.