NPIMap

Individual provider Active NPI

Jodi Beth Khouri, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1902007024
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085002427 Issued in IL
Practice address
676 N Saint Clair St Ste 2000
Chicago, IL 60611-3147
Phone
(312) 695-5620
Fax
(312) 695-7095
NPI assigned
May 29, 2007
Last updated
Sep 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6833 AZ
Physician Assistant 363A00000X 085002427 IL Primary
Medical Physician Assistant 363AM0700X 085.002427 IL

Addresses

Primary practice location

676 N Saint Clair St Ste 2000
Chicago, IL 60611-3147

Mailing address

676 N Saint Clair St Ste 2000
Chicago, IL 60611-3147
Phone (312) 695-5620

Other identifiers 1

IdentifierTypeStateIssuer
085-002427OtherILIL STATE LIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100916000274 TX Practitioner - Physician Assistant 0345365177 Reassigns benefits to 1 organization
I20190715000382 IL Practitioner - Physician Assistant 0345365177 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

259 E Erie St
Chicago, IL 60611-2930
Phone (312) 503-1944

4445 W Irving Park Rd
Chicago, IL 60641-2808

675 N Saint Clair St
Chicago, IL 60611-5975

675 N St Clair
Chicago, IL 60611-5975

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085002427ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Sep 1, 2010 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2023 Accepting new patients
Howard Brown Health Center CurrentSince Jul 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince May 1, 2023 Accepting new patients
Howard Brown Health Center CurrentSince Jul 1, 2019 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Sep 1, 2010 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Howard Brown Health Center Past Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

Dept 5777
Carol Stream, IL 60122

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

676 N Saint Clair St
Ste 2000
Chicago, IL 60611

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

Organizations & group practices 9

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 8

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": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1902007024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2000",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113147",
            "telephone_number": "312-695-5620",
            "fax_number": "312-695-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 2000",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113147",
            "telephone_number": "312-695-5620",
            "fax_number": "312-695-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOURI",
        "first_name": "JODI",
        "middle_name": "BETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6833",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002427",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085.002427",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LIC",
            "identifier": "085-002427",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.