Antoun Al Khabbaz, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Rockford, IL
NPI 1992797260 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1992797260
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 036116757 (IL)
- Practice address
- 1200 W State St
Rockford, IL 61102-2112 - Phone
- (815) 490-1600
- Fax
- (815) 490-1485
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Crusaders Central Clinic Association
Practice addresses (Care Compare)
1100 Broadway
Rockford, IL 61104-1429
Phone (815) 490-1600
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061218000098 | IL | Practitioner - Obstetrics/Gynecology | 7517954548 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37213 | KY | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crusaders Central Clinic Association | Current |
Accepting new patients | |
| Crusaders Central Clinic Association | Multi-Specialty | Current |
Accepting new patients |
Locations
1050 Logan Ave
Belvidere, IL 61008
Phone (815) 547-0282
6115 N 2nd St
Loves Park, IL 61111
Phone (815) 516-0040
1100 Broadway
Rockford, IL 61104
Phone (815) 490-1354
1215 N Alpine Rd
Rockford, IL 61107
Phone (815) 391-7700
1200 W State St
Rockford, IL 61102
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 37213 | KY | |
| Obstetrics & Gynecology Physician |
207V00000X | 036116757 | IL | Yes |
Addresses
Primary practice location
1200 W State St
Rockford, IL 61102-2112
Mailing address
1200 W State St
Rockford, IL 61102-2112
Phone (815) 490-1600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036116757 | Other | IL | ILLINOIS LICENSE |
| 64054091 | Medicaid | KY | |
| 336077827 | Other | IL | ILLINOIS CONTROLLED SUB |
Other providers in Rockford, IL
- Sanaiya Ahmed
- Shaheen Ahmed
- Sultan Ahmed
- Cassandra Aker
- Isra Mahdi Al Jamed
- Moamen Mohammad Al Zoubi
- Amira Al-Basha
- Maria I Al-Basha
- Aida Alanis
- Diana Elizabeth Alanis
All providers in Rockford, IL · Obstetrics & Gynecology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.