Mazen Kherallah, MD

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

9502 Issued in ND

Practice address

801 Broadway N
Fargo, ND 58102-3641

Phone

(701) 234-7200

Fax

(701) 234-7225

NPI assigned

Jul 17, 2006

Sex

Male

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 ND, IL, MO, MN4 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 4

Specialty

Critical Care (Intensivists)

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Sanford Health of Northern MinnesotaGroup PAC ID 5597725168, 349 clinicians

Critical Care Physicians of Illinois LLCGroup PAC ID 7012179294, 41 clinicians

Landmark Hospital of Joplin LLCGroup PAC ID 5698870822, 8 clinicians

Insight Chicago IncGroup PAC ID 2860894706, 140 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
• Insight Hospital and Medical Center Chicago Hospital, Chicago, IL, CCN 140158
• Sanford Bemidji Medical Center Hospital, Bemidji, MN, CCN 240100
• Franciscan Health Olympia & Chicago Heights Hospital, Olympia Fields, IL, CCN 140172

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924
  Medicare reassignment Care Compare group NPD
• Critical Care Physicians of Illinois LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Aurora, IL
  • NPI 1508134966
  Medicare reassignment Care Compare group NPD
• Insight Chicago, Inc.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1881261006
  Medicare reassignment Care Compare group NPD
• Landmark Hospital of Joplin, LLC

  • Long Term Care Hospital
  • Joplin, MO
  • NPI 1972633410
  Medicare reassignment Care Compare group NPD
• Sanford Health of Northern Minnesota

  • Family Medicine Physician
  • Kelliher, MN
  • NPI 1770849697
  Medicare reassignment Care Compare group NPD
• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  NPD
• Dr. Almasri and Associates Inc.

  • Clinic/Center
  • Palos Heights, IL
  • NPI 1104158286
  NPD
• Insight Chicago, Inc.

  • Rehabilitation Hospital Unit
  • Chicago, IL
  • NPI 1154308518
  NPD
• Sanford Health of Northern Minnesota

  • Mental Illness Community Based Residential Treatment Facility
  • Bemidji, MN
  • NPI 1093278764
  NPD
• Sanford Health of Northern Minnesota

  • Internal Medicine Physician
  • Bemidji, MN
  • NPI 1780628149
  NPD
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1245519081
  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  Care Compare affiliation
• Sanford Medical Center Fargo

  • Air Ambulance
  • Fargo, ND
  • NPI 1942415468

  Hospital

  Care Compare affiliation
• Franciscan Health Olympia Fields

  • General Acute Care Hospital
  • Olympia Fields, IL
  • NPI 1588771919
  Care Compare affiliation
• Insight Chicago, Inc.

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1730166224
  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Ambulatory Surgical Clinic/Center
  • Bemidji, MN
  • NPI 1093876922

  Hospital

  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Internal Medicine Physician
  • Bemidji, MN
  • NPI 1780628149

  Hospital

  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Rural Acute Care Hospital
  • Bemidji, MN
  • NPI 1801870191
  Care Compare affiliation

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613260800000",
    "number": "1922025691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-7200",
            "fax_number": "701-234-7225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-7200",
            "fax_number": "701-234-7225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHERALLAH",
        "first_name": "MAZEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-02-14",
        "certification_date": "2021-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "ND",
            "license": "9502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bishal Khadka
• Kamran John Khaghany, M.D.
• Hasrat Khan, MBBS
• Saad Saleem Khan, MD
• Darshan Singh Khangura, M.D.
• Lena Khibnik, LAPC
• Seema Khosla, MD
• Naella Khoury, LPN
• Aslam Khuder
• Kaitlyn Kidder

• Critical Care Medicine (Internal Medicine) Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Critical Care Medicine (Internal Medicine) Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.