Individual provider Active NPI

Mina Mecheal Benjamin Mehanni, MD, MS

  • Cardiovascular Disease Physician
  • Milwaukee, WI
National Provider Identifier
1902186166
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
2022045774 Issued in MO
Practice address
9200 W Wisconsin Ave FL 4
Milwaukee, WI 53226-3522
Phone
(414) 805-6850
Fax
(414) 805-6851
NPI assigned
Aug 19, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Ultrasound Physician 2085U0001X 036152915 IL
Cardiovascular Disease Physician 207RC0000X 2022045774 MO Primary
Internal Medicine Physician 207R00000X BP10040686 TX
Internal Medicine Physician 207R00000X 62448 WI
Internal Medicine Physician 207R00000X 036152915 IL

Addresses

Primary practice location

9200 W Wisconsin Ave FL 4
Milwaukee, WI 53226-3522

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (636) 916-7272

Other identifiers 1

IdentifierTypeStateIssuer
1902186166MedicaidWI

Other names 1

  • Mina Mecheal Benjamin Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220602001844 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2163664087 Reassigns benefits to 3 organizations
I20221203000078 MO Practitioner - Cardiovascular Disease (Cardiology) 2163664087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 617-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62448WIMDInternal Medicine Physician
036152915ILMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Multi-Specialty Group Internal Medicine CurrentSince Sep 14, 2023 Accepting new patients
SSM Health Care Group Internal Medicine CurrentSince Dec 1, 2022 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 19, 2022 Accepting new patients
Proctor Health Systems CurrentSince Jul 19, 2022 Accepting new patients
SSM Health Care Group CurrentSince Dec 1, 2022 Accepting new patients
Proctor Health Systems Internal Medicine CurrentSince Jul 19, 2022 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 19, 2022 Accepting new patients
SSM-Sluh Inc Past Accepting new patients
Stoughton Hospital Association Past Accepting new patients
SSM Medical Group Inc. Past Accepting new patients
Physician Groups LC Internal Medicine PastSince May 4, 2025 Accepting new patients

Locations

1776 Westlakes Pkwy
Ste 400
West Des Moines, IA 50266
Phone (515) 241-6161

2 Saint Anthonys Way
Ste 305
Alton, IL 62002
Phone (618) 462-2222

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A1
Peoria, IL 61602

5401 N Knoxville Ave
Ste 217
Peoria, IL 61614
Phone (309) 282-1864

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

1034 S Brentwood Blvd
Ste 1120
Saint Louis, MO 63117
Phone (314) 977-4600

Interoperability endpoints

  • Direct secure messaging: mmehanni440050@direct-ehr-ssmhc.com

Organizations & group practices 12

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 6

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": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1902186166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "636-916-7272",
            "fax_number": "636-916-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE FL 4",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-6850",
            "fax_number": "414-805-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHANNI",
        "first_name": "MINA",
        "middle_name": "MECHEAL BENJAMIN",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-19",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "IL",
            "license": "036152915",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "2022045774",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP10040686",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "62448",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036152915",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902186166",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "20 Progress Point Pkwy Ste 200",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633682207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MINA",
            "last_name": "BENJAMIN",
            "middle_name": "MECHEAL",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.