Individual provider Active NPI

Shadab Ali Khan, M.D.

  • Vascular & Interventional Radiology Physician
  • Rockford, IL
National Provider Identifier
1952729915
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
036143740 Issued in IL
Practice address
5666 E State St
Rockford, IL 61108-2425
Phone
(815) 227-2512
Fax
(779) 227-6158
NPI assigned
Apr 6, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 036143740 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

5666 E State St
Rockford, IL 61108-2425

Mailing address

3714 Peregrine Way
Elgin, IL 60124-7880
Phone (585) 489-9524

Other practice location 1

1740 W Taylor St
Chicago, IL 60612-7232
Phone (866) 600-2273

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200526000596 IL Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 6103128129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Rochester School of Medicine and Dentistry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Consultants of Rockford LTDGroup PAC ID 3274596572, 24 clinicians

Practice addresses (Care Compare)

1401 E State St
Rockford, IL 61104-2315
Phone (815) 968-4400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.95 of 100Reported as group
Quality
90.59
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Consultants of Rockford LTD CurrentSince May 1, 2020 Accepting new patients

Locations

39020 Eagle Way
Chicago, IL 60678

903 Commerce Dr
Ste 333
Oak Brook, IL 60523
Phone (630) 571-6770

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

1340 Charles St
Ste 404
Rockford, IL 61104
Phone (815) 316-8346

Organizations & group practices 1

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 3

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": "1396742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1952729915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3714 PEREGRINE WAY",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601247880",
            "telephone_number": "585-489-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5666 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082425",
            "telephone_number": "815-227-2512",
            "fax_number": "779-227-6158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1740 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127232",
            "country_code": "US",
            "telephone_number": "866-600-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SHADAB",
        "middle_name": "ALI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-06",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036143740",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.