NPIMap

Individual provider Active NPI

Ata Motamedi, MD

  • Internal Medicine Physician
  • Olney, MD
National Provider Identifier
1013904606
Registry record updated Dec 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0063999 Issued in MD
Practice address
17904 Georgia Ave
Suite # 304
Olney, MD 20832-2239
Phone
(301) 924-2790
Fax
(301) 924-1631
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0063999 MD Primary

Addresses

Primary practice location

17904 Georgia Ave
Suite # 304
Olney, MD 20832-2239

Mailing address

PO Box 309
Olney, MD 20830-0309
Phone (301) 924-2790

Other identifiers 7

IdentifierTypeStateIssuer
P00307411OtherMDRR MEDICARE
132355OtherMDJHHC
1194549OtherMDAETNA HMO
65112701OtherMDCAREFIRST BCBS
409839100MedicaidMD
0033OtherDCCAREFIRST BCBS
5901543OtherMDAETNA PPO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070711000376 DC Practitioner - Internal Medicine 0042221723

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota, Duluth School of Medicine, 1994
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

17904 Georgia Ave
Olney, MD 20832-2278

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0063999MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Motamedi and Associates Internal Medicine,PC Internal Medicine CurrentSince Nov 15, 2006 Accepting new patients
Medstar Harbor Hospital Physicians LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Sacred Heart Healthcare System Internal Medicine Past Accepting new patients
Anne Arundel Medical Center Inc Past Accepting new patients
Commonwealth Inpatient Physicians, LLC Past Accepting new patients
Harbor Hospital Past Accepting new patients
Sacred Heart Healthcare System Internal Medicine Past Accepting new patients

Locations

17904 Georgia Ave
Ste 304
Olney, MD 20832
Phone (301) 213-9267

17904 Georgia Ave
Ste 110
Olney, MD 20832
Phone (301) 260-0949

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HJDIDD/Endpoint/HJDIDD
  • FHIR API: https://fhir4.healow.com/fhir/r4/HJDIDD

Organizations & group practices 8

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 5

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356566400000",
    "number": "1013904606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208300309",
            "telephone_number": "301-924-2790",
            "fax_number": "301-924-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17904 GEORGIA AVE",
            "address_2": "SUITE # 304",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208322239",
            "telephone_number": "301-924-2790",
            "fax_number": "301-924-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTAMEDI",
        "first_name": "ATA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2012-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0063999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00307411",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC",
            "identifier": "132355",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "1194549",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "65112701",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409839100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "0033",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "5901543",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olney, MD

Sources for this page

Verify at the official NPI Registry.