NPIMap

Individual provider Active NPI

Mir Abdul Karim Moshref, MD

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1073610689
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01042546 Issued in IN
Practice address
2110 Lower Huntington Rd
Fort Wayne, IN 46819-1235
Phone
(260) 478-9960
Fax
(260) 478-9670
NPI assigned
Sep 19, 2006
Last updated
Dec 9, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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 01042546 IN Primary

Addresses

Primary practice location

2110 Lower Huntington Rd
Fort Wayne, IN 46819-1235

Mailing address

2110 Lower Huntington Rd
Fort Wayne, IN 46819-1235
Phone (260) 478-9960

Other identifiers 2

IdentifierTypeStateIssuer
100332850MedicaidIN
000000176706OtherINANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050707000523 IN Practitioner - Family Practice 0244140580 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2110 Lower Huntington Rd
Fort Wayne, IN 46819-1235
Phone (260) 478-9960

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions157
Skin biopsy14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01042546INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Karim Moshref MD PC CurrentSince Aug 1, 2000 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
St. Joseph Health System, LLC Past Accepting new patients

Locations

2110 Lower Huntington Rd
Fort Wayne, IN 46819
Phone (219) 478-9960

6050 S 800 E
#92
Fort Wayne, IN 46814
Phone (260) 625-3545

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Coventry MeadowsFort Wayne, IN, CCN 155756 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 15, 2018
Apr 13, 2026

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386547200000",
    "number": "1073610689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LOWER HUNTINGTON RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468191235",
            "telephone_number": "260-478-9960",
            "fax_number": "260-478-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 LOWER HUNTINGTON RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468191235",
            "telephone_number": "260-478-9960",
            "fax_number": "260-478-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSHREF",
        "first_name": "MIR ABDUL KARIM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-19",
        "last_updated": "2013-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01042546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100332850",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000176706",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.