Active NPI
Mohammed A. Mubarak, DDS
- Dentist
- Cleveland, OH
National Provider Identifier
1083831762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2560
- Practice address
- 2500 Metrohealth Dr
Cleveland, OH 44109-1900 - Phone
- (216) 778-7800
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2560 | OH | Primary |
Addresses
Primary practice location
2500 Metrohealth Dr
Cleveland, OH 44109-1900
Mailing address
12540 Edgewater Dr
Apt. 402
Lakewood, OH 44107-1683
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150724012357 | CA | Order and Referring Only - Dentist | 6406169069 | |
| I20160309002906 | OH | Order and Referring Only - Dentist | 6406169069 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2560 | OH | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083831762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12540 EDGEWATER DR",
"address_2": "APT. 402",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441071683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 METROHEALTH DR",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441091900",
"telephone_number": "216-778-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUBARAK",
"first_name": "MOHAMMED",
"middle_name": "A.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "2560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- 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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.