Mohammad Islam

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

35.145446 Issued in OH

Practice address

1272 W Main St Ste 503
Newark, OH 43055-2058

Phone

(220) 564-1805

Fax

(220) 564-1806

NPI assigned

Jul 1, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Pulmonary Disease

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Licking Memorial Health ProfessionalsGroup PAC ID 6204740731, 235 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Licking Memorial Hospital Hospital, Newark, OH, CCN 360218
• Knox Community Hospital Hospital, Mount Vernon, OH, CCN 360040

Merit-based Incentive Payment System (MIPS)

Final score

85.98 of 100Reported as group

Quality

75.66

Promoting interoperability

100

Improvement activities

40

Cost

75.38

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• OH PPO
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6

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.

• Licking Memorial Health Professionals

  • Family Medicine Physician
  • Newark, OH
  • NPI 1326072265
  Medicare reassignment Care Compare group NPD
• Licking Memorial Professional Corporation

  • Durable Medical Equipment & Medical Supplies
  • Newark, OH
  • NPI 1326436510
  NPD
• Licking Memorial Professional Corp.

  • Surgery Physician
  • Newark, OH
  • NPI 1366461386
  NPD (past)
• Licking Memorial Professional Corp.

  • Pediatrics Physician
  • Utica, OH
  • NPI 1497771521
  NPD (past)

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

• Knox Community Hospital

  • General Acute Care Hospital
  • Mount Vernon, OH
  • NPI 1295761963
  Care Compare affiliation
• Licking Memorial Hospital

  • General Acute Care Hospital
  • Newark, OH
  • NPI 1568446755
  Care Compare affiliation

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

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1003268095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 W MAIN ST STE 503",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552058",
            "telephone_number": "220-564-1805",
            "fax_number": "220-564-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAM",
        "first_name": "MOHAMMAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-01",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OH",
            "license": "35.145446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mislam29161@lickingmemorial.medicity.net",
            "affiliation": "N",
            "address_1": "1272 W Main St Ste 503",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430552058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tina Idleman
• Marilyn Kay Inceoglu, LISW-S
• Brittany Ingersoll
• Jessica Lynn Inskeep, CDCA
• Joel Isaacson
• Shannon Italiano, RN
• Diane Ivery
• Jack L Neely and Holly L Hanbaum PTR
• David M Jackson, MD
• Quinetta Jackson

• Pulmonary Disease Physician in Newark, OH
• Providers in Newark, OH by specialty
• Pulmonary Disease Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.