Mohammad Reza Ghazi-Moghadam, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

132638 Issued in NY

Practice address

425 Guy Park Ave
Suite 203
Amsterdam, NY 12010-1043

Phone

(518) 843-1449

Fax

(518) 843-8215

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Urology

Education

Other, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Mary'S HealthcareGroup PAC ID 7618960709, 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Healthcare Hospital, Amsterdam, NY, CCN 330047

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• St. Mary'S Healthcare

  • Psychiatric Hospital Unit
  • Amsterdam, NY
  • NPI 1164497103

  Corporate Director

  CMS ownership
• St. Mary'S Healthcare

  dba Wilkinson Residential Health Care Facility

  • Skilled Nursing Facility
  • Amsterdam, NY
  • NPI 1366683344

  Corporate Director

  CMS ownership
• St. Mary'S Healthcare

  • Rehabilitation Hospital Unit
  • Amsterdam, NY
  • NPI 1427290709

  Corporate Director

  CMS ownership
• St. Mary'S Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1811977796

  Corporate Director

  CMS ownership
• St. Mary'S Hospital at Amsterdam

  • Medicare Defined Swing Bed Hospital Unit
  • Amsterdam, NY
  • NPI 1659513521

  Corporate Director

  CMS ownership

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.

• St Marys Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1518926401
  Medicare reassignment Care Compare group NPD
• St. Mary'S Healthcare

  dba Opioid Treatment Program

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Amsterdam, NY
  • NPI 1700636347
  NPD
• St. Mary'S Healthcare

  • Psychiatric Hospital Unit
  • Amsterdam, NY
  • NPI 1164497103
  NPD (past)

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

• St. Mary'S Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1811977796
  Care Compare affiliation

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023183746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 GUY PARK AVE",
            "address_2": "SUITE 203",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101043",
            "telephone_number": "518-843-1449",
            "fax_number": "518-843-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 GUY PARK AVE",
            "address_2": "SUITE 203",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101043",
            "telephone_number": "518-843-1449",
            "fax_number": "518-843-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAZI-MOGHADAM",
        "first_name": "MOHAMMAD",
        "middle_name": "REZA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "132638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Michelle Garcia-Betancourt, FNP
• Nicole Elise Garhartt, OTR/L
• Amanda Genzer, LCSW
• Teddy Allen Germain, LPN
• Ghari Richardson MD Foa PC
• Vincent John Giaimo, D.D.S.
• Susan R Gifford, RN
• Gustavo A Gil, D.M.D.
• Mary Eileen Gilston, LCSW-R
• Tori Gonputh

• Specialist in Amsterdam, NY
• Providers in Amsterdam, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.