Mohanned Hassan Mohammed Ahmed, M.D.
Individual provider Active NPI Family Medicine Physician · Pine Bluff, AR
NPI 1053725499 · NPPES record last updated Jul 23, 2019
Key facts
- NPI
- 1053725499
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-11695 (AR)
- Practice address
- 1600 W 40TH Ave
Pine Bluff, AR 71603-6301 - Phone
- (870) 541-7100
- Fax
- (870) 541-7204
- NPI assigned
- Jun 13, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 11
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Vincent Medical Group
Monticello Ess LLC
Practice addresses (Care Compare)
2 Saint Vincent Cir
Little Rock, AR 72205-5423
Phone (501) 552-4666
778 Scogin Dr
Monticello, AR 71655-5729
Phone (870) 367-2411
Hospital & facility affiliations
- CHI-St Vincent Infirmary
- Baptist Health Medical Center-Drew County
- St Vincent Medical Center/North
- Conway Regional Medical Center, Inc
- Jefferson Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- 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 |
|---|---|---|---|---|
| I20181108001977 | AR | Practitioner - Family Practice |
0345539680 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-11695 | AR | MD | Emergency Medicine Physician |
| 4301104828 | MI | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Vincent Medical Group | Family Medicine | Current |
Accepting new patients |
| Concord Medical Group of Texas PLLC | Emergency Medicine | Current |
Accepting new patients |
| Ess of Fordyce LLC | Emergency Medicine | Current |
Accepting new patients |
| Southeast Arkansas Emergency Physicians LLP | Emergency Medicine | Current |
Accepting new patients |
| Southeast Arkansas Emergency Physicians LLP | Emergency Medicine | Current |
Accepting new patients |
| Concord Medical Group PLLC | Emergency Medicine | Current |
Accepting new patients |
| Hospital Care Consultants of Fordyce LLC | Current |
Accepting new patients | |
| Arkansas Emergency Staffing Solutions, Inc | Emergency Medicine | Current |
Accepting new patients |
| Monticello Ess LLC | Emergency Medicine | Current |
Accepting new patients |
| Qcpi-Villagemd, PC | Family Medicine | Past | Accepting new patients |
Locations
451 W Locke St
Ashdown, AR 71822
Phone (870) 265-5351
1015 Unity Rd
Crossett, AR 71635
Phone (870) 364-0590
201 N Clifton St
Fordyce, AR 71742
Phone (870) 352-6300
1801 Martin Luther King Jr Dr
Helena, AR 72342
Phone (870) 338-5800
2729 S Highway 65 82
Lake Village, AR 71653
Phone (870) 265-5351
16221 Saint Vincent Way
Little Rock, AR 72223
Phone (501) 221-0888
2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680
778 Scogin Dr
Monticello, AR 71655
Phone (870) 367-2411
1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100
2215 Wildwood Ave
Sherwood, AR 72120
Phone (501) 522-7100
Interoperability endpoints
- mohanned.ahmed.1@14285.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | E-11695 | AR | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 4301104828 | MI | |
| General Practice Physician | 208D00000X | 074885 | GA | |
| Family Medicine Physician | 207Q00000X | E-11695 | AR | Yes |
Addresses
Primary practice location
1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Mailing address
4166 Snapfinger Woods Dr
Decatur, GA 30035-3411
Phone (404) 289-6199
Other practice location 1
4166 Snapfinger Woods Dr
Decatur, GA 30035-3411
Phone (404) 289-6199
Other practice location 2
4201 S Mulberry St
Pine Bluff, AR 71603-7016
Phone (870) 541-8660
Other providers in Pine Bluff, AR
- Adetola Adeniyi
- Advanced O&P Techniques
- Affinity Healthcare for Women
- Affinity Palliative Arkansas, LLC
- Aracely Elizabeth Aguirre
- Syed Ammar Ahmed
- Aj'S Health & Wellness Enterprises PLLC
- Clinton Akin
- Ashok Akula
- Mohamad Al Saadi
All providers in Pine Bluff, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2019. 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.