Individual provider Active NPI

Mojgan Sarmadi, M.D.

  • Family Medicine Physician
  • Lebanon, IN
National Provider Identifier
1033442108
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01072209A Issued in IN
Practice address
504 W Camp St
Lebanon, IN 46052-1647
Phone
(765) 482-7005
NPI assigned
Sep 8, 2009
Last updated
Jan 21, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01072209A IN Primary

Addresses

Primary practice location

504 W Camp St
Lebanon, IN 46052-1647

Mailing address

504 W Camp St
Lebanon, IN 46052-1647
Phone (765) 482-7005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20131004000509 IN Practitioner - Family Practice 8628202603 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01072209AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coze Health Medical, LLC Family Medicine CurrentSince Mar 1, 2019 Accepting new patients
Indiana Spine Group, PC Past Accepting new patients

Locations

1281 Win Hentschel Blvd
West Lafayette, IN 47906
Phone (765) 761-4334

156 Sagamore Pkwy W
#A
West Lafayette, IN 47906
Phone (765) 204-1122

Interoperability endpoints

  • Direct secure messaging: mojgan.sarmadi@293173640429572.direct.elationemr.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390262400000",
    "number": "1033442108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 W CAMP ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521647",
            "telephone_number": "765-482-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W CAMP ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521647",
            "telephone_number": "765-482-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARMADI",
        "first_name": "MOJGAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-08",
        "last_updated": "2014-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01072209A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, IN

Sources for this page

Verify at the official NPI Registry.